Variation among hospitals in selection of higher-cost, "higher-tech," implantable cardioverter-defibrillators: data from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter/Defibrillator (ICD) Registry.

Background: New implantable cardioverter/defibrillator (ICD) models are regularly introduced, incorporating technological advantages. The purpose of this study was to determine factors associated with use of a newer, higher-tech/higher-cost device, as opposed to a previously released device, among patients undergoing ICD implantation.
Methods: We analyzed the 78,494 cases receiving new ICD implants submitted by 978 hospitals to the NCDR ICD Registry between January 2005 and June 2007. Devices were categorized as "previously released" 3 months after a new model from the same manufacturer was released. A nonparsimonious model including all demographic, clinical, provider, and hospital characteristics was created using logistic regression to predict use of a previously released device.
Results: Overall, 36% of implants involved previously released devices. However, no demographic (race, gender, payor status), clinical, or provider characteristics had a meaningful impact on use of previously released devices. The model C-statistic was 0.602, suggesting that measured characteristics had a limited ability to differentiate those receiving a previously released device. However, individual hospitals varied greatly in use of "previously released" devices, from 3% in the lowest decile to 91% in the top decile. Among physicians implanting at >1 hospital, there was minimal correlation between use of previously released devices between hospitals, suggesting hospital policies or culture, rather than physician preference, drives the large interhospital variation seen.
Conclusions: The use of "previously released" devices is influenced minimally by measured patient or provider characteristics. Rather, the main determinant of whether patients receive the newest, versus a previously released device, appears to be practice patterns at individual hospitals.
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