title: A Comparison of ICD implantations in the United States versus Italy.
abstract: BACKGROUND
  The benefits conferred by implantable cardioverter defibrillators (ICDs) have expanded to primary prevention. The advancements in ICD therapy (ACT) registry in the United States and the Italian ICD registry (IIR) examine changing trends in ICD implantation in their respective countries. Data from these registries may be useful for comparison of transcontinental differences in ICD utilization.
  
  
  METHODS
  This study includes initial implantations in patients enrolled in ACT and IIR. A comparative analysis was performed for device indications based on primary or secondary prevention. Sub-group analyses by device types (single, dual chamber, or cardiac resynchronization) were performed.
  
  
  RESULTS
  This analysis included 4,547 primary implantations in ACT and 6,491 in IIR. The groups were similar with respect to age. There were 82% primary and 18% secondary prevention indications in ACT, versus 42% primary and 58% secondary prevention indications in IIR (P < 0.001). There was a significantly higher rate of dual chamber ICD implants in ACT than in IIR for both primary (35.7% vs 23.7%, P < 0.001) and secondary prevention (52.3% vs 36.9%, P < 0.001). Conversely, more CRT-D were implanted in IIR than in ACT (primary prevention 46.5% vs 32.0%; secondary prevention 29.0% vs 13.0%, P < 0.001).
  
  
  CONCLUSIONS
  Significant differences were observed in the types of indications for ICDs between ACT and IIR. Device prescription differed significantly between countries. The specific reasons for differences in ICD implantation patterns in these two countries are unclear. These observations warrant further investigations to determine if these differences are associated with different qualities of life and clinical outcomes.
authors.affiliation: St. Francis Hospital, Roslyn, New York, USA. smgpace@aol.com
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Epstein
authors.forename: Thomas
authors.initials: T
authors.lastname: Deering
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Goldman
authors.forename: Marco
authors.initials: M
authors.lastname: Ghidina
authors.forename: Curtis
authors.initials: C
authors.lastname: Neason
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000208:ethnology / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D014481:United States