Varying implantable cardioverter defibrillator referral patterns from implanting and non-implanting hospitals.
OBJECTIVE
To assess the impact of hospital type on implantable cardioverter defibrillation (ICD) prescription rates.


RESULTS
The Wessex Cardiothoracic Unit is a regional implanting centre serving eight district general hospitals (DGHs). We audited all new ICD implants performed in our institution over 4 years. Hospitals implanting or referring patients elsewhere were excluded. We categorized patients into three different groups depending on local hospital type-regional centre (one hospital), DGH with a device specialist (one hospital), DGH without a device specialist (two hospitals). For each hospital type, we assessed the overall implant rate based on local population. There were 459 new ICD implants; of which 381 were included in the analysis. Implant rates were higher in areas whose local hospital was a regional centre (103/million/year), when compared with DGHs with (49/million/year) or without a device specialist (48/million/year). This disparity was greatest with respect to coronary artery disease primary prevention indications-implant rates 29, 14, and 9/million/year, respectively.


CONCLUSIONS
ICD implant rates are affected by hospital type and are significantly higher in regional centres when compared with DGHs. To increase ICD implant rates, the widespread implementation of clinical pathways to identify prospective primary prevention patients may be needed.
Scott
Paul A
PA
Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, UK. paul.andrew.scott@btinternet.com
Turner
Nicholas G
NG
Chungh
Aman
A
Morgan
John M
JM
Roberts
Paul R
PR
D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012041:Regional Medical Programs / Q000145:classification / Q000706:statistics & numerical data*; D006113:United Kingdom