Abstract 15033: Utilization of Cardiac Resynchronization Therapy Among Eligible Patients Receiving an Implantable Cardioverter-Defibrillator: Insights From the NCDR ICD Registry

Abstract

Introduction: Although ICDs are used inconsistently among eligible patients, it is unknown if similar variation exists in the use of cardiac resynchronization therapy (CRT) devices. Methods: Within the National Cardiovascular Data Registry (NCDR) ICD Registry, we identified 72,115 patients with a class I or IIa indication for CRT according to 2008 guidelines who underwent ICD or CRTD implantation at 1521 hospitals between April 1, 2010 and June 30, 2014. A hierarchical model including hospital specific random-effects was used to identify patient, provider, and hospital factors associated with CRTD use. We then determined risk-standardized rates of CRTD use across hospitals for the overall population and by strength of guideline indication. We applied 2012 CRT guidelines in secondary analyses. Results: A total of 62,900 (87.2%) eligible patients by 2008 guidelines received CRTD, with 60,730 (84.2%) having a class I indication and 11,385 (15.8%) a class IIa indication for CRTD. Patient factors associated with higher use included increasing age (OR 1.07, 95% CI 1.04-1.1) and NYHA class IV symptoms (OR 1.13, 95% CI 1.02-1.25) while black race was associated with lower use of CRTD (OR 0.81, 95% CI 0.75-0.88). Non-electrophysiology providers were less likely to implant CRTD (OR 0.35, 95% CI 0.28-0.43). After accounting for patient, provider, and hospital factors, the median hospital risk standardized rate of CRTD use was 77.3% (range 24.3-100%) (Figure). The hospital median risk standardized rate of CRTD for class I indication was 79% (range 32.5-100%) and for class IIa was 83.9% (range 79.8-100%). Similar findings were seen with the application of 2012 CRTD guidelines. Conclusions: Among patients receiving device therapy who have guideline based indications for CRTD, the use of this therapy varies widely by hospital even after accounting for patient, provider, and hospital factors. Strategies to address this variation may improve patient outcomes through optimal use of CRTD.