Research data collection and manuscript preparation were funded, in part, by Medtronic, Inc., Minneapolis, Minnesota.
Implantable Cardioverter Defibrillator Utilization Based on Discharge Diagnoses from Medicare and Managed Care Patients
Article first published online: 12 AUG 2003
© Futura Publishing Company, Inc. 2002
Journal of Cardiovascular Electrophysiology
Volume 13, Issue 1, pages 38–43, January 2002
How to Cite
RUSKIN, J. N., CAMM, A. J., ZIPES, D. P., HALLSTROM, A. P. and MCGRORY-USSET, M. E. (2002), Implantable Cardioverter Defibrillator Utilization Based on Discharge Diagnoses from Medicare and Managed Care Patients. Journal of Cardiovascular Electrophysiology, 13: 38–43. doi: 10.1046/j.1540-8167.2002.00038.x
Drs. Ruskin, Camm, and Zipes are consultants for Medtronic, Inc. Ms. McGrory-Usset is an employee of Medtronic, Inc.
This manuscript was processed by a guest editor.
- Issue published online: 12 AUG 2003
- Article first published online: 12 AUG 2003
- Manuscript received 6 July 2001; Accepted for publication 26 November 2001.
- Cited By
- implantable cardioverter defibrillator;
- implant rates;
- ventricular tachycardia;
- ventricular fibrillation;
- sudden cardiac death;
- claims-based study
ICD Utilization.Introduction: Implantable cardioverter defibrillators (ICDs) have become an accepted therapy for patients at high risk of sudden cardiac death. To assess the current utilization of this therapy, we estimated the number of patients at risk of sudden death using an historical claims-based study and compared these results to current ICD usage volumes.
Methods and Results: Managed care and Medicare databases (claims related to 4.6 million covered U.S. lives during a 12-month period) were analyzed to identify patients who had either a primary or secondary diagnosis of ventricular tachycardia, ventricular fibrillation, ventricular flutter, or cardiac arrest. These patients were further required to have a diagnosis code indicating a previous myocardial infarction or congestive heart failure. Patients who died during the study period or did not have medical insurance were excluded. In the base case scenario, 1,226 patients per million population were identified as potential ICD candidates. Sensitivity analyses reduced that value to a range from 736 to 1,140 ICD candidates per million population. Sensitivity factors considered included acute myocardial infarction, comorbidities, age, secondary ventricular tachycardia/ventricular fibrillation diagnosis, and varying degrees of left ventricular dysfunction. These results contrast with an ICD usage rate of 416 per million population in the United States and lower rates in other countries.
Conclusion: This study suggests that, based on discharge diagnoses, many patients who could benefit from ICDs are not receiving this therapy. Diverse reasons for this underutilization should be addressed to improve access to, and appropriate use of, this therapy.