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Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure

View Article: PubMed Central - PubMed

ABSTRACT

Background: Cardiac implantable electric devices are commonly used to treat heart failure. Little is known about temporal and geographic variation in use of cardiac resynchronization therapy (CRT) devices in usual care settings.

Methods and results: We identified new CRT with pacemaker (CRT‐P) or defibrillator generators (CRT‐D) implanted between 2008 and 2013 in the United States from a commercial claims database. For each implant, we characterized prior medication use, comorbidities, and geography. Among 17 780 patients with CRT devices (median age 69, 31% women), CRT‐Ps were a small and increasing share of CRT devices, growing from 12% to 20% in this study period. Compared to CRT‐D recipients, CRT‐P recipients were older (median age 76 versus 67), and more likely to be female (40% versus 30%). Pre‐implant use of β‐blockers and angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers was low in both CRT‐D (46%) and CRT‐P (31%) patients. The fraction of CRT‐P devices among all new implants varied widely across states. Compared to the increasing national trend, the share of CRT‐P implants was relatively increasing in Kansas and relatively decreasing in Minnesota and Oregon.

Conclusions: In this large, contemporary heart failure population, CRT‐D use dwarfed CRT‐P, though the latter nearly doubled over 6 years. Practice patterns vary substantially across states and over time. Medical therapy appears suboptimal in real‐world practice.

No MeSH data available.


Annual device implant proportions in MarketScan. Each line represents the number of patients receiving each new implant type divided by the total number of enrollees in each year. CRT‐D indicates CRT with ICD backup; CRT‐P, cardiac resynchronization therapy pacemaker; ICD, implantable cardioverter defibrillator.
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jah31666-fig-0003: Annual device implant proportions in MarketScan. Each line represents the number of patients receiving each new implant type divided by the total number of enrollees in each year. CRT‐D indicates CRT with ICD backup; CRT‐P, cardiac resynchronization therapy pacemaker; ICD, implantable cardioverter defibrillator.

Mentions: Figure 3 displays the percentage of people who received new implants out of the entire MarketScan population in each year. Medicare Advantage enrollees, who are older than commercial enrollees, had higher proportions of all implant types. In 2013, for every 100 000 Medicare enrollees, there were 11 CRT‐P recipients, 33.8 CRT‐D recipients, and 58 ICD recipients. In the commercial population, these numbers were 0.4, 2.9, and 10.6, respectively. For the remaining results, we combined the commercial and Medicare populations.


Geographic and Temporal Variation in Cardiac Implanted Electric Devices to Treat Heart Failure
Annual device implant proportions in MarketScan. Each line represents the number of patients receiving each new implant type divided by the total number of enrollees in each year. CRT‐D indicates CRT with ICD backup; CRT‐P, cardiac resynchronization therapy pacemaker; ICD, implantable cardioverter defibrillator.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015279&req=5

jah31666-fig-0003: Annual device implant proportions in MarketScan. Each line represents the number of patients receiving each new implant type divided by the total number of enrollees in each year. CRT‐D indicates CRT with ICD backup; CRT‐P, cardiac resynchronization therapy pacemaker; ICD, implantable cardioverter defibrillator.
Mentions: Figure 3 displays the percentage of people who received new implants out of the entire MarketScan population in each year. Medicare Advantage enrollees, who are older than commercial enrollees, had higher proportions of all implant types. In 2013, for every 100 000 Medicare enrollees, there were 11 CRT‐P recipients, 33.8 CRT‐D recipients, and 58 ICD recipients. In the commercial population, these numbers were 0.4, 2.9, and 10.6, respectively. For the remaining results, we combined the commercial and Medicare populations.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Cardiac implantable electric devices are commonly used to treat heart failure. Little is known about temporal and geographic variation in use of cardiac resynchronization therapy (CRT) devices in usual care settings.

Methods and results: We identified new CRT with pacemaker (CRT‐P) or defibrillator generators (CRT‐D) implanted between 2008 and 2013 in the United States from a commercial claims database. For each implant, we characterized prior medication use, comorbidities, and geography. Among 17 780 patients with CRT devices (median age 69, 31% women), CRT‐Ps were a small and increasing share of CRT devices, growing from 12% to 20% in this study period. Compared to CRT‐D recipients, CRT‐P recipients were older (median age 76 versus 67), and more likely to be female (40% versus 30%). Pre‐implant use of β‐blockers and angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers was low in both CRT‐D (46%) and CRT‐P (31%) patients. The fraction of CRT‐P devices among all new implants varied widely across states. Compared to the increasing national trend, the share of CRT‐P implants was relatively increasing in Kansas and relatively decreasing in Minnesota and Oregon.

Conclusions: In this large, contemporary heart failure population, CRT‐D use dwarfed CRT‐P, though the latter nearly doubled over 6 years. Practice patterns vary substantially across states and over time. Medical therapy appears suboptimal in real‐world practice.

No MeSH data available.