Utilization and in-hospital complications of cardiac resynchronization therapy: trends in the United States from 2003 to 2013.
Cardiac resynchronization therapy (CRT) device implantation has been shown to reduce morbidity and mortality in selected patients with heart failure. We sought to investigate the utilization and in-hospital complications of cardiac resynchronization therapy defibrillator (CRT-D) and pacemaker (CRT-P) implantations in the United States from 2003 to 2013.



Patients receiving CRT-D or CRT-P were identified in the National Inpatient Sample database (NIS), using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes. Annual implantation rates, patient demographics, co-morbidities, in-hospital complications, and length of stay were analysed. From 2003 to 2013, an estimated total of 439 010 (95% CI: 406 723-471 296) inpatient CRT implantations were performed in the U.S. The median age of patients was 72 and 71% were male. Overall, 6.1% had at least one complication. During the study period, comorbidity index and overall complication rate increased (P = 0.002 and P = 0.01, respectively). Mortality and length of stay showed no significant trend. Predictors of complications included: age 65 and older, female sex (OR: 1.19; 95% CI: 1.12-1.27), Deyo-Charlson Comorbidity Index, and elective admission (OR: 0.61; 95% CI: 0.57-0.66).



From 2003 to 2013, the severity of comorbid conditions increased and a rising trend was observed in the rate of periprocedural complications among patients undergoing CRT in the United States. In-hospital mortality and length of stay showed no uniform trend.
Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Seyed Mohammadreza
SM
Hosseini
Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Kasra
K
Moazzami
Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Guy
G
Rozen
Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Jeena
J
Vaid
Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Ahmed
A
Saleh
Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Kevin E
KE
Heist
Department of Biostatistics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Mark
M
Vangel
Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.|Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Jeremy N
JN
Ruskin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Cardiac resynchronization therapy ; Complication ; Defibrillator ; Pacemaker