title: Implantable cardioverter-defibrillators in France: practices and regional variability.
abstract: OBJECTIVE
  The rates of cardiac defibrillator implantation (ICD) in Europe and within countries are heterogeneous. We examined the characteristics of ICD recipients and device implantation rates in France, with the goal of identifying patterns and regional differences in medical practices.
  
  
  RESULTS
  We compiled the information available on devices and patients from a manufacturer's database for the years 2008 and 2009 and the Stidefix national registry from January 2008 to April 2010 and reported the descriptive statistics and comparisons of implantation practices among regions. We analysed data from 10 766 patients enrolled in Stidefix (mean age=63 ± 13 years; 83% men) after implantation of single-chamber (24%), dual-chamber (33%), or triple-chamber (43%) ICD. Implantation was for primary prevention in 63% of patients. Between 2008 and 2009, the national implant rate increased from 126 to 147 per million inhabitants, with regional variations related to the number of cardiologists and of implant centres. Patients were significantly older and more likely to undergo implantation for primary prevention or for cardiac resynchronization therapy (CRT) in higher-volume regions. In Ile de France (Paris and its suburbs), patients tended to be younger, as in low-implantation regions, but with a high rate of CRT implants, as in high-implantation regions. A comparison of the Stidefix data with the manufacturer's database revealed that only 57% of all ICD implanted in 2009 were reported to Stidefix.
  
  
  CONCLUSIONS
  Despite an increasing rate of ICD implantation in France, important regional disparities persist, with a median position occupied by Ile de France.
authors.affiliation: InParys Clinical Research Associates, St Cloud 92210, France. lazarus@inparys.com
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lazarus
authors.forename: Nelly
authors.initials: N
authors.lastname: Biondi
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Thébaut
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: Michel
authors.initials: M
authors.lastname: Chauvin
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012042:Registries; D012189:Retrospective Studies