title: Temporal trends in quality of care among recipients of implantable cardioverter-defibrillators: insights from the National Cardiovascular Data Registry.
abstract: BACKGROUND
  The ICD Registry was established in 2006 in part to measure quality of care in patients undergoing implantation of implantable cardioverter-defibrillators (ICDs); however, whether outcomes have improved since initiation of the registry is unknown. Our objective was to examine changes over time in 3 quality metrics available from the registry.
  
  
  RESULTS
  We performed an observational study of 367 153 patients who received new ICD implants from April 2006 to March 2010. Three quality metrics were selected: Adverse events (in-hospital complications or mortality), optimal medical therapy (OMT), and cardiac resynchronization therapy (CRT). OMT was defined as prescription of β-blocker and either angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in eligible patients. CRT eligibility was determined by QRS ≥120 ms, left ventricular ejection fraction ≤35%, and New York Heart Association class III/IV. Observation periods were divided into four 12-month intervals. We analyzed changes over time and used hierarchical logistic regression to adjust for potential confounders. Adverse events decreased over time (3.7% to 2.8%, P<0.001). Among eligible patients, rates of OMT and CRT increased over time (OMT: 69.0% to 74.3%, P<0.001; CRT: 80.5% to 84.2%, P<0.001). After adjustment for potential confounders, patients were significantly less likely to experience adverse events in year 4 than in year 1 (odds ratio, 0.75; 95% confidence interval, 0.71-0.79) and significantly more likely to receive OMT (odds ratio, 1.29; 95% confidence interval, 1.26-1.32) and CRT (odds ratio, 1.42; 95% confidence interval, 1.35-1.49).
  
  
  CONCLUSIONS
  Since initiation of the ICD Registry, adverse events have been decreasing, and rates of OMT and CRT among eligible patients have been increasing, although there is still significant room for improvement.
authors.affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA (J.A.D.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (R.L., Y.W., J.P.C.); Mayo Clinic, Rochester, MN (S.C.H.); and University of Colorado Anschutz Medical Campus, Denver, CO (P.V.).
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.forename: Rachel
authors.initials: R
authors.lastname: Lampert
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.forename: Paul
authors.initials: P
authors.lastname: Varosy
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000592:standards / Q000639:trends*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016208:Databases, Factual / Q000639:trends*; D017147:Defibrillators, Implantable / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards / Q000639:trends*; D012042:Registries; D013997:Time Factors
keywords: cardioverter-defibrillators, implantable; electrophysiology; quality of health care; registries