title: Factors influencing utilization of the primary prevention implantable defibrillator.
abstract: BACKGROUND
  A growing literature suggests underutilization of the primary prevention implantable cardioverter-defibrillator (ICD); thus, factors influencing utilization need to be understood. We performed a comprehensive assessment of patient characteristics and health insurance status among subjects eligible for primary prevention ICD in a tertiary care center.
  
  
  METHODS
  From among a group of patients who met criteria for primary prevention ICD based on left ventricular dysfunction (LVEF ≤ 35%), ICD recipients (n = 110) were compared to ICD non-recipients (n = 110) to identify determinants of ICD implantation. We evaluated demographics, clinical profile including Charlson Comorbidity Index [CCI, categorized as low (≤3) or high (>3)] and health insurance status.
  
  
  RESULTS
  ICD recipients were younger (62.1±15.0 vs. 68.0±18.2; P = 0.01), with more males (80% vs. 65.5%; P = 0.01), higher NYHA class (II/III: 75.5% vs. 40.2%; P<0.001) and more likely to have supplemental private health insurance (61.8% vs. 46.4%; P = 0.02). CCI was not significantly different between the two groups (low CCI 61.8% vs. 62.7%; P = 0.89). In multivariable analysis, factors independently associated with ICD implantation were male sex (OR, 2.77, [1.31-5.85]; P = 0.01), age<75 (OR, 2.68, [1.30-5.50]; P = 0.01), private insurance (OR, 2.17, [1.08-4.36], P = 0.03) and NYHA Class II/III (OR, 5.91, [2.91-12.01]; P<0.001). Documentation of discussion about primary prevention ICD was absent in the majority (57.2%) of non-recipients.
  
  
  CONCLUSIONS
  In a contemporary urban tertiary care setting, age, sex and heart failure symptom class were associated with ICD utilization, with socioeconomic/insurance status also potentially playing a role. These findings have implications for optimizing appropriate utilization of the prophylactic ICD and warrant follow-up in larger, more diverse populations.
authors: Shanghai Jiaotong University School of Public Health, Shanghai, China.
authors: Lin
authors: L
authors: Zhang
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors: Kumar
authors: K
authors: Narayanan
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors: Harpriya
authors: H
authors: Chugh
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors: Takahiro
authors: T
authors: Shiota
authors: Shanghai Jiaotong University School of Public Health, Shanghai, China.
authors: Zhi-Jie
authors: ZJ
authors: Zheng
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors: Sumeet S
authors: SS
authors: Chugh
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention