title: Cardiac Resynchronization Therapy: US Trends and Disparities in Utilization and Outcomes.
abstract: BACKGROUND
  The use of cardiac resynchronization therapy (CRT) has increased significantly since its initial approval in 2001 for use in patients with advanced heart failure. However, trends in utilization of CRT have not been systematically characterized.
  
  
  RESULTS
  We used the Nationwide Inpatient Sample database to identify all patients with CRT implantation during 2002 to 2010. The overall trends in CRT device implantation, patient characteristics, and outcomes were examined in detail and compared among demographic subgroups. During 2002 to 2010, a total of 374,202 CRT procedures were recorded. Significant and persistent gender and racial disparities favoring men (71.4%) and white (79.6%), respectively, were noted in all years. The highest number of CRT devices were implanted in the 65- to 84-year age group (64.6%), with significant increase in number of CRT implants in older patients ≥ 85 years over the years (P = 0.02). The CRT-associated in-hospital mortality improved from 1.08% in 2003 to 0.70% in 2010 (P = 0.03). The correlates of higher mortality included males (0.93% versus 0.71% in females; P = 0.04) and older age (age ≥ 85 years had 1.5% mortality versus 0.8% for age < 85 year; P < 0.001). The mean hospital length of stay for CRT decreased, while mean CRT-associated hospital charges increased progressively over the years. Factors associated with higher charges were gender (males > females), older age, and greater comorbidities.
  
  
  CONCLUSIONS
  CRT implantation is a relatively safe procedure that has become safer in higher risk patients. However, significant disparities in CRT utilization exist in certain demographic subgroups, and these disparities have persisted across the years.
authors.affiliation: From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.R.M.S., B.L.W.); Department of Medicine, AtlantiCare Regional Medical Center, Atlantic City, NJ (V.Y.); Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City (Y.M.R., D.L., B.D.); Department of Medicine, University of Kansas Medical Center, Kansas City (S.P.); and Virginia Commonwealth University, Richmond (D.P.).
authors.forename: Arun Raghav Mahankali
authors.initials: AR
authors.lastname: Sridhar
authors.affiliation: From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.R.M.S., B.L.W.); Department of Medicine, AtlantiCare Regional Medical Center, Atlantic City, NJ (V.Y.); Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City (Y.M.R., D.L., B.D.); Department of Medicine, University of Kansas Medical Center, Kansas City (S.P.); and Virginia Commonwealth University, Richmond (D.P.).
authors.forename: Vivek
authors.initials: V
authors.lastname: Yarlagadda
authors.affiliation: From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.R.M.S., B.L.W.); Department of Medicine, AtlantiCare Regional Medical Center, Atlantic City, NJ (V.Y.); Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City (Y.M.R., D.L., B.D.); Department of Medicine, University of Kansas Medical Center, Kansas City (S.P.); and Virginia Commonwealth University, Richmond (D.P.).
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Parasa
authors.affiliation: From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.R.M.S., B.L.W.); Department of Medicine, AtlantiCare Regional Medical Center, Atlantic City, NJ (V.Y.); Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City (Y.M.R., D.L., B.D.); Department of Medicine, University of Kansas Medical Center, Kansas City (S.P.); and Virginia Commonwealth University, Richmond (D.P.).
authors.forename: Yeruva Madhu
authors.initials: YM
authors.lastname: Reddy
authors.affiliation: From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.R.M.S., B.L.W.); Department of Medicine, AtlantiCare Regional Medical Center, Atlantic City, NJ (V.Y.); Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City (Y.M.R., D.L., B.D.); Department of Medicine, University of Kansas Medical Center, Kansas City (S.P.); and Virginia Commonwealth University, Richmond (D.P.).
authors.forename: Dhavalkumar
authors.initials: D
authors.lastname: Patel
authors.affiliation: From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.R.M.S., B.L.W.); Department of Medicine, AtlantiCare Regional Medical Center, Atlantic City, NJ (V.Y.); Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City (Y.M.R., D.L., B.D.); Department of Medicine, University of Kansas Medical Center, Kansas City (S.P.); and Virginia Commonwealth University, Richmond (D.P.).
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.R.M.S., B.L.W.); Department of Medicine, AtlantiCare Regional Medical Center, Atlantic City, NJ (V.Y.); Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City (Y.M.R., D.L., B.D.); Department of Medicine, University of Kansas Medical Center, Kansas City (S.P.); and Virginia Commonwealth University, Richmond (D.P.).
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
authors.affiliation: From the Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.R.M.S., B.L.W.); Department of Medicine, AtlantiCare Regional Medical Center, Atlantic City, NJ (V.Y.); Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City (Y.M.R., D.L., B.D.); Department of Medicine, University of Kansas Medical Center, Kansas City (S.P.); and Virginia Commonwealth University, Richmond (D.P.). bdawn@kumc.edu.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs / Q000639:trends; D019538:Health Care Surveys; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology / Q000639:trends*; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D044469:Racial Groups; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: cardiac resynchronization therapy; disparities; outcome; trends; utilization