Implantable cardioverter defibrillator utilization based on discharge diagnoses from Medicare and managed care patients.
BACKGROUND
Implantable cardioverter defibrillators (ICDs) have become an accepted therapy for patients at high risk of sudden cardiac death. To assess the current utilization of this therapy, we estimated the number of patients at risk of sudden death using an historical claims-based study and compared these results to current ICD usage volumes.


RESULTS
Managed care and Medicare databases (claims related to 4.6 million covered U.S. lives during a 12-month period) were analyzed to identify patients who had either a primary or secondary diagnosis of ventricular tachycardia, ventricular fibrillation, ventricular flutter, or cardiac arrest. These patients were further required to have a diagnosis code indicating a previous myocardial infarction or congestive heart failure. Patients who died during the study period or did not have medical insurance were excluded. In the base case scenario, 1,226 patients per million population were identified as potential ICD candidates. Sensitivity analyses reduced that value to a range from 736 to 1,140 ICD candidates per million population. Sensitivity factors considered included acute myocardial infarction, comorbidities, age, secondary ventricular tachycardia/ventricular fibrillation diagnosis, and varying degrees of left ventricular dysfunction. These results contrast with an ICD usage rate of 416 per million population in the United States and lower rates in other countries.


CONCLUSIONS
This study suggests that, based on discharge diagnoses, many patients who could benefit from ICDs are not receiving this therapy. Diverse reasons for this underutilization should be addressed to improve access to, and appropriate use of, this therapy.
Ruskin
Jeremy N
JN
Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. jruskin@partners.org
Camm
A John
AJ
Zipes
Douglas P
DP
Hallstrom
Alfred P
AP
McGrory-Usset
Mary E
ME
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002017:Budgets; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000191:economics / Q000706:statistics & numerical data* / Q000600:supply & distribution; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D010351:Patient Discharge; D012017:Referral and Consultation; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000628:therapy