Utilization of implantable cardioverter-defibrillators in survivors of cardiac arrest in the United States from 1996 to 2001.
OBJECTIVE
We analyzed the incidence of implantable cardioverter-defibrillator (ICD) therapy in survivors of cardiac arrest (CA) in the U.S. from 1996 through 2001.


BACKGROUND
Cardiac arrest is a class I indication for ICD therapy. The current patterns of ICD utilization in survivors of CA have not been fully examined.


METHODS
We searched a representative sample of all hospital discharges for patients admitted with the primary diagnosis of CA who survived to hospital discharge. Patients with a concomitant diagnosis of acute myocardial infarction or previous ICD in situ were excluded.


RESULTS
From 1996 to 2001, 113,262 patients were admitted for CA. Of those, 63,745 (56.3%) did not survive to hospital discharge. Of the remaining 49,517 patients, 30.7% received an ICD before discharge, with a gradual increase in implantation rates from 1996 (23.6%) to 2001 (46.3%). Using logistic regression for the years 2000 and 2001, patients who were discharged without an ICD were older (odds ratio [OR] 0.93 for every 10-year increase in age, p < 0.001), more likely to be African American (OR 0.19, p < 0.001), and more likely to be admitted to a smaller hospital (OR 2.24 for each additional 100 beds, p < 0.001). These predictors were independent of other co-morbid illnesses.


CONCLUSIONS
Although they are increasing, the rates of ICD therapy after CA remain very low. There are gross discrepancies by race. At a time when newer indications for ICD implantation are emerging, efforts should be focused on identifying the causes of this underutilization and discrepancies in survivors of CA.
Voigt
Andrew
A
Cardiovascular Institute, University of Pittsburgh, Pennsylvania, USA.
Ezzeddine
Rana
R
Barrington
William
W
Obiaha-Ngwu
Ogundu
O
Ganz
Leonard I
LI
London
Barry
B
Saba
Samir
S
D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology