Recent trends in utilization of implantable cardioverter-defibrillators in survivors of cardiac arrest in the United States.
BACKGROUND
Cardiac arrest (CA) is a class I indication for implantable defibrillator (ICD) therapy. We studied the trend of ICD utilization in survivors of CA in the US population between 2002 and 2006.


METHODS
We searched the National Hospital Discharge Survey 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 implantation were excluded.


RESULTS
From 2002 to 2006, 758 patients were surveyed representing 88,920 discharges. Of those, 396 (52.2%) representing 48,098 discharges did not survive to hospital discharge. Of the remaining 362 (representing 38,855) patients, 38.4% received an ICD prior to discharge. Independent predictors of in-hospital mortality included older age, female gender, black race, smaller hospital of discharge, and a higher number of organ failures (P<0.001 for all). Using logistic regression, patients who were discharged with an ICD were more likely to have been discharged from a larger hospital (odds ratio=2.35 for each additional 100 beds, P<0.001) and to be less sick (odds ratio=0.85 for each additional organ failure, P<0.001). There was no gender or racial discrepancy in the ICD utilization after CA.


CONCLUSIONS
Despite their class I indication after CA, ICDs continue to be underutilized, but the previously documented racial gaps have disappeared. Our data reveal a large discrepancy in ICD utilization by the size of the discharge hospital, which may suggest regional influences and gaps in resource allocations. Future studies looking into the root causes of these discrepancies and possible remedies are warranted.
Saba
Samir
S
Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA. sabas@upmc.edu
Ravipati
Lakshmi Prasad
LP
Voigt
Andrew
A
D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014600:Utilization Review