title: Trends and outcomes of cardiac resynchronization therapy upgrade procedures: A comparative analysis using a United States National Database 2003-2013.
abstract: While outcomes after de novo cardiac resynchronization therapy (CRT) implantations have been reported, there are limited data on CRT upgrade procedures.
  
  
  
  The purpose of this study was to examine trends and in-hospital outcomes of patients undergoing CRT upgrade procedures by using a large national inpatient database.
  
  
  
  Using the National Inpatient Sample database, we identified all patients undergoing CRT upgrade and de novo CRT implants between 2003 and 2013. Rates of in-hospital adverse events such as death, cardiac perforation, pneumothorax, and lead revision were examined. Multivariate regression analysis was performed to compare outcomes after CRT upgrade and those after de novo CRT implant procedures.
  
  
  
  Between 2003 and 2013, 19,546 CRT upgrade procedures and 464,246 de novo CRT implants were recorded. Rates of in-hospital mortality of patients undergoing CRT upgrade were significantly higher than those of patients undergoing de novo CRT implant (1.9% vs 0.8%; P < .001). Compared with de novo CRT implants, CRT upgrades were independently associated with increased mortality (adjusted odds ratio [OR] 1.91; 95% confidence interval [CI] 1.67-2.19; P < .001), cardiac perforation (OR 3.20; 95% CI 2.71-3.77; P < .001), and need for lead revision (OR 2.09; 95% CI 1.88-2.3; P < .001).
  
  
  
  In a large national inpatient cohort, CRT upgrade procedures were associated with higher rates of in-hospital mortality and procedural complications as compared with de novo CRT implants.
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York. Electronic address: jac9029@med.cornell.edu.
authors.forename: Jim W
authors.initials: JW
authors.lastname: Cheung
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: James E
authors.initials: JE
authors.lastname: Ip
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Markowitz
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: George
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Lerman
authors.affiliation: Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Luke K
authors.initials: LK
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019233:Retreatment / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Cardiac resynchronization therapy; Cardiac resynchronization therapy upgrade; Complications; Mortality