title: Use of Cardiac Resynchronization Therapy Among Eligible Patients Receiving an Implantable Cardioverter Defibrillator: Insights From the National Cardiovascular Data Registry Implantable Cardioverter Defibrillator Registry.
abstract: Cardiac resynchronization therapy (CRT) reduces the risk for mortality and heart failure-related events in select patients. Little is known about the use of CRT in combination with an implantable cardioverter defibrillator (ICD) in patients who are eligible for this therapy in clinical practice.
  
  
  
  To (1) identify patient, clinician, and hospital characteristics associated with CRT defibrillator (CRT-D) use and (2) determine the extent of hospital-level variation in the use of CRT-D among guideline-eligible patients undergoing ICD placement.
  
  
  
  Multicenter retrospective cohort from 1428 hospitals participating in the National Cardiovascular Data Registry ICD Registry between April 1, 2010, and June 30, 2014. Adult patients meeting class I or IIa guideline recommendations for CRT at the time of device implantation were included in this study.
  
  
  
  Implantation of an ICD with or without CRT.
  
  
  
  A total of 63 506 eligible patients (88.6%) received CRT-D at the time of device implantation. The mean (SD) ages of those in the ICD and CRT-D groups were 67.9 (12.2) years and 68.4 (11.5) years, respectively. In hierarchical multivariable models, black race was independently associated with lower use of CRT-D (odds ratio [OR], 0.77; 95% CI, 0.71-0.83) as was nonprivate insurance (OR, 0.90; 95% CI, 0.85-0.95 for Medicare and OR, 0.73; 95% CI, 0.65-0.82 for Medicaid). Clinician factors associated with greater CRT-D use included clinician implantation volume (OR, 1.01 per 10 additional devices implanted; 95% CI, 1.01-1.01) and electrophysiology training (OR, 3.13 as compared with surgery-boarded clinicians; 95% CI, 2.50-3.85). At the hospital level, the overall median risk-standardized rate of CRT-D use was 79.9% (range, 26.7%-100%; median OR, 2.08; 95% CI, 1.99-2.18).
  
  
  
  In a national cohort of patients eligible for CRT-D at the time of device implantation, nearly 90% received a CRT-D device. However, use of CRT-D differed by race and implanting operator characteristics. After accounting for these factors, the use of CRT-D continued to vary widely by hospital. Addressing disparities and variation in CRT-D use among guideline-eligible patients may improve patient outcomes.
authors.affiliation: University of Colorado School of Medicine, Aurora.
authors.forename: Lucas N
authors.initials: LN
authors.lastname: Marzec
authors.affiliation: University of Colorado School of Medicine, Aurora2Denver Health Medical Center, Denver, Colorado.
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Haikun
authors.initials: H
authors.lastname: Bao
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: University of Colorado School of Medicine, Aurora.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: University of Colorado School of Medicine, Aurora4Veterans Affairs Eastern Colorado Health Care System, Denver.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
authors.affiliation: University of Colorado School of Medicine, Aurora4Veterans Affairs Eastern Colorado Health Care System, Denver.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D002037:Bundle-Branch Block / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000706:statistics & numerical data*; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D006333:Heart Failure / Q000628:therapy*; D006761:Hospitals / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D009026:Mortality; D017202:Myocardial Ischemia / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States; D044465:White People / Q000706:statistics & numerical data