Variation in use of dual-chamber implantable cardioverter-defibrillators: Results from the National Cardiovascular Data Registry

Abstract

Background: Among patients without an indication for a pacemaker, current evidence is inconclusive whether a dual-chamber implantable cardioverter- defibrillator (ICD) is superior to a single-chamber ICD. The current use of dual-chamber ICDs is not well characterized. Methods: We conducted a cross-sectional study exploring hospital-level variation in the use of dual-chamber ICDs across the United States. Patients receiving a primary prevention ICD from 2006 through 2009 without a documented indication for a pacemaker were included. Multivariate hierarchical logistic regression was used to explore patient, health care provider, and physician factors related to the use of a dual-chamber device. Results: Dual-chamber devices were implanted in 58% of the 87 115 patients without a pacing indication among 1293 hospitals, with hospital rates ranging from 0% in 33 centers to 100% in 109 centers. In multivariate analysis, geographic region was a strong independent predictor of dual-chamber device use, ranging from 36.4% in New England (reference region) to 66.4% in the Pacific region (odds ratio [OR], 5.25; 95% CI, 3.35-8.21). Hospital clustering was assessed using a median OR which was 3.96, meaning that 2 identical patients at different hospitals would have nearly a 4-fold difference in their chance of receiving a dual-chamber ICD. Conclusions: Use of dual-chamber ICDs for the primary prevention of sudden cardiac death among patients without an indication for permanent pacing varies markedly at the hospital level in the United States. This is a clear example of how practice can vary independent of patient factors. ©2012 American Medical Association. All rights reserved.