1. Variation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes.
- Author
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Chui PW, Lan Z, Freeman JV, Enriquez AD, Khera R, Akar JG, Masoudi FA, Ong EL, and Curtis JP
- Subjects
- Humans, Aged, United States epidemiology, Medicare, Treatment Outcome, Hospitals, Cardiac Resynchronization Therapy, Defibrillators, Implantable, Heart Failure therapy
- Abstract
Background: Despite strong guideline recommendations for cardiac resynchronization therapy-defibrillator (CRT-D) in select patients, this therapy is underutilized with substantial variation among hospitals, and the association of this variation with outcomes is unknown., Objective: The purpose of this study was to assess whether facility variation in CRT-D utilization is associated with differences in hospital-level outcomes., Methods: We linked Medicare claims data with the National Cardiovascular Data Registry's ICD Registry from 2010 to 2015. We calculated the intraclass correlation coefficient to quantify the degree of variation in patient-level CRT use that can be explained by interfacility variation on a hospital level. To quantify the degree of hospital variation in patient-level outcomes (all-cause mortality, readmissions, and cardiac readmissions) that can be attributed to variations in CRT-D use, we utilized multilevel modeling., Results: The study included 30,134 patients across 1377 hospitals. The median rate of CRT-D implantation in those meeting guideline indications was 89%, but there was a wide variation across hospitals. After adjustment, most of the variation (74%) in hospital rates of CRT-D utilization was attributable to the hospital in which the patient was treated. Differences in hospital CRT-D utilization was associated with 8.76%, 5.26%, and 4.71% of differences in hospital mortality, readmissions, and cardiac readmission rates, respectively (P < .001 for all outcomes)., Conclusion: There is a wide variation in the use of CRT-D across hospitals that was not explained by case mix. Hospital-level variation in CRT-D utilization was associated with clinically significant differences in outcomes. A measure of CRT-D utilization in eligible patients may serve as a useful metric for quality improvement efforts., (Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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