Utilization, Outcomes and Costs of Implantable Cardioverter Defibrillators in Italy: A Population-Based Analysis Using Healthcare Administrative Databases.

2014 ◽  
Vol 1 (2) ◽  
pp. 48-56
Author(s):  
Fabiana Madotto ◽  
◽  
Carla Fornari ◽  
Virginio Chiodini ◽  
Lorenzo G Mantovani ◽  
...  
Keyword(s):  
Population Based ◽  
Administrative Databases ◽  
Implantable Cardioverter Defibrillators ◽  
Cardioverter Defibrillators

Inequitable distribution of implantable cardioverter defibrillators in Ontario

2007 ◽  
Vol 23 (3) ◽  
pp. 354-361 ◽  
Author(s):  
Jacob A. Udell ◽  
David N. Juurlink ◽  
Alexander Kopp ◽  
Douglas S. Lee ◽  
Jack V. Tu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Fold Increase ◽  
Population Based ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Coronary Syndrome ◽  
Patients With Heart Failure ◽  
History Of ◽  
And Gender ◽  
Cardioverter Defibrillators

Objectives:Implantable cardioverter defibrillator (ICD) therapy reduces the risk of sudden death in patients with ischemic cardiomyopathy, but their novelty and cost may represent barriers to utilization. The objective of this study was to examine the influence of age, gender, place of residence, and socioeconomic status on rates of ICD implantation for the primary prevention of death.Methods:We conducted a population-based retrospective cohort study involving the entire province of Ontario, Canada. Patients were eligible if they had survived following hospitalization for heart failure from 1 January 1993, to 31 March 2004, and previously sustained an acute coronary syndrome within 5 years. Patients with an existing ICD or a documented history of cardiac arrest were excluded, as were patients who died in the hospital. Primary outcome was ICD implantation.Results:We identified 48,426 patients hospitalized for heart failure who survived to hospital discharge. Of these, 440 received an ICD, with a gradual 30-fold increase in implantation rates over the study period (.12–3.9 percent). ICD recipients were more likely to be men (odds ratio [OR] = 4.14; 95 percent confidence interval [CI], 3.24–5.30), younger than 75 years of age (OR = 3.19; 95 percent CI, 2.57–3.96), reside in a metropolitan area (OR = 1.42; 95 percent CI, 1.04–1.9), and live in a higher socioeconomic neighborhood (OR = 1.32; 95 percent CI, 1.08–1.61).Conclusions:Among patients with heart failure and a previous myocardial infarction, ICD use is increasing in Ontario. However, the application of this technology is characterized by major sociodemographic inequities. The causes and consequences of the pronounced age and gender discrepancies, in particular, warrant further investigation.

scholarly journals Implantable cardioverter-defibrillators and subsequent cancer risk: a nationwide population-based cohort study

EP Europace ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 902-908 ◽  
Author(s):  
Susanne Bendesgaard Pedersen ◽  
Jens Cosedis Nielsen ◽  
Hans Erik Bøtker ◽  
Dóra Körmendiné Farkas ◽  
Morten Schmidt ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cancer Risk ◽  
Population Based ◽  
Implantable Cardioverter Defibrillators ◽  
Cardioverter Defibrillators ◽  
Subsequent Cancer

Design and implementation of a population-based registry of implantable cardioverter defibrillators (ICDs) in Ontario

Heart Rhythm ◽  
2008 ◽  
Vol 5 (9) ◽  
pp. 1250-1256 ◽  
Author(s):  
Douglas S. Lee ◽  
David Birnie ◽  
Douglas Cameron ◽  
Eugene Crystal ◽  
Paul Dorian ◽  
...  
Keyword(s):  
Population Based ◽  
Implantable Cardioverter Defibrillators ◽  
Design And Implementation ◽  
Population Based Registry ◽  
Cardioverter Defibrillators

Abstract 4128: Evaluating Sex Differences in Population-Based Utilization of Implantable Cardioverter Defibrillators (ICDs): The Role of Cardiac Conditions and Non-Cardiac Comorbidities

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Derek R MacFadden ◽  
Jack V Tu ◽  
Alice Chong ◽  
Peter C Austin ◽  
Douglas S Lee
Keyword(s):  
Cardiac Arrest ◽  
Sex Differences ◽  
Primary Prevention ◽  
Cox Regression ◽  
Population Based ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Cardioverter Defibrillators ◽  
Information Database

BACKGROUND: Although sex differences exist in the use of ICDs, reasons for the disparities are poorly understood. We determined if age, comorbid conditions, or ICD indication explained the sex differences. METHODS: We examined all patients in Ontario, Canada, with cardiac arrest (CA, 1998 –2007), myocardial infarction (MI, 2002–2007), or heart failure (HF, 2005–2007), using the Canadian Institute for Health Information Database. MI and HF cohorts excluded those with prior CA, and included patients post-MADIT-2 and SCD-HeFT trials. Patients were followed until ICD implant using Cox regression, with hazard ratio (HR) >1.0 indicating greater likelihood of ICD implant in men. RESULTS: Among 9246 patients eligible for ICD implantation after CA, 237 (2.6%) women and 725 (7.8%) men received ICDs. In 105,516 primary prevention MI patients, 172 (0.2%) women and 836 (0.8%) men received ICDs. Among 61,160 primary prevention HF patients, 221 (0.4%) women and 852 (1.4%) men received ICDs. The rate of ICD implant was significantly higher in men across indications adjusting for age, prior arrhythmia, and comorbidities (Figure ). Post-CA, the HR for secondary prevention ICD was 1.92 (95%CI, 1.66 –2.23). Men were more likely to undergo ICD implant than women for primary prevention, with HRs 3.00 (95%CI, 2.53–3.55) post-MI and 3.01 (95%CI, 2.59 –3.50) in HF patients. Although death after primary prevention ICD did not differ by sex, mortality risk was higher in men after CA (HR 1.42; 95%CI, 1.03–1.95). CONCLUSIONS: Differences in ICD use for all indications were not explained by age or comorbidities. Despite increased use, men had reduced post-implant survival after cardiac arrest.

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