title: Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Acute Myocardial Infarction.
abstract: OBJECTIVE
  Implantable cardioverter-defibrillators (ICDs) are not recommended within 40 days of myocardial infarction (MI); thus, ICD implantation might not be considered during the post-MI care transition.
  
  
  OBJECTIVE
  To examine ICD implantation rates and associated mortality among older MI patients with low ejection fraction (EF).
  
  
  METHODS
  Retrospective observational study of Medicare beneficiaries with an EF of 35% or less after MI, treated at 441 US hospitals between 2007 and 2010, excluding patients with prior ICD implantation. Follow-up data were available through December 2010.
  
  
  METHODS
  ICD implantation within 1 year of MI vs no ICD implantation within 1 year of MI.
  
  
  METHODS
  Patient characteristics associated with receiving an ICD within 1 year after discharge and 2-year mortality associated with ICD implantation.
  
  
  RESULTS
  Among 10,318 MI patients with EF of 35%or lower, the cumulative 1-year ICD implantation rate was 8.1% (95%CI, 7.6%-8.7%). Patients with ICD implantation were more likely to have prior coronary artery bypass graft procedures, higher peak troponin levels, in-hospital cardiogenic shock, and cardiology follow-up within 2 weeks after discharge relative to patients who did not receive an ICD within 1 year. Implantation of ICD was associated with lower 2-year mortality (15.3 events per 100 patient-years [128 deaths in 838 patient-years] vs 26.4 events per 100 patient-years [3033 deaths in 11 479 patient-years]; adjusted HR, 0.64; 95%CI, 0.53-0.78). [table: see text]
  
  
  CONCLUSIONS
  In this large registry study of older patients who experienced MI from 2007-2010, fewer than 1 in 10 eligible patients with low EF received an ICD within 1 year after MI, although ICD implantation was associated with lower risk-adjusted mortality at 2 years. Additional research is needed to determine evidence-based approaches to increase ICD implantation among eligible patients.
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Pokorney
authors.affiliation: Department of Cardiovascular Electrophysiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Miller
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Ahmanson Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas.
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina2Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D012737:Sex Factors; D013318:Stroke Volume; D014336:Troponin / Q000097:blood; D014481:United States / Q000453:epidemiology
chemical_list: D014336:Troponin