Abstract 353: Variations in Implantable Cardioverter Defibrillator (ICD) Utilization in the Louisiana Health System

Abstract

The emergence of implantable cardiac device technology has rapidly changed the way in which patients with chronic ventricular dysfunction are evaluated and medically treated. Effectiveness of cardioverter defibrillator (ICD) devices across patient subgroups such as age needs more evaluation. Several clinical variables have been associated with lack of survival benefit despite the overall 5-7% mortality rate over a period of 2- 4 years. The overall objective of this Quality Improvement Initiative is to investigate the prevalence and variation in ICD utilization by hospital characteristics, income, or cardiovascular risk factor prevalence, as well as the related survival outcome among heart failure patients in the Louisiana State University health system. All patients diagnosed with chronic heart failure between 1999 through June 30, 2012 within Louisiana State University Health Care Services Division (LSUHCSD) were selected from the Disease Management Evaluation Database (DMED). Seven hospitals in Louisiana contribute to the patient population. Prevalence was calculated for heart failure and ICD utilization; chi square test were used to explore the variation of ICD utilization by hospital characteristics and multiple cardiovascular risk factors. There have been approximately 39,830 patients diagnosed with heart failure in the LSUHCSD hospitals over the last 13 years. Among heart failure patients identified, 3.6% have an ICD. There is slightly higher proportion of females than males with heart failure in the population; however, ICDs are higher among men (p-value <0.001). African-Americans have a higher rate of heart failure in the population and receipt of ICD than Whites (p-value = 0.005). Approximately 67% of the population has 2 or more listed comorbidities, with 12% having 5 or more comorbidities. The incidence of heart failure patients in LSU HCSD has decreased; however, the rate of ICD has increased over the last decade. The facility with the most heart failure and ICD patients identified is the largest facility, the Public Hospital in New Orleans, LA. However, the rate of ICD among heart failure patients is highest at the Medical Center, in Bogalusa, LA (17.3% compared to 12.4%). This facility has the highest proportion of Medicare patients. Underutilization of ICDs can be identified in the LSUHCSD system. Variability for medical care including interventions can have multiple causes including market factors that reflect hospital attributes such as the type of cardiac services provided, managed care penetration, socioeconomic status and disease burden including risk factors such as those for cardiovascular disease (like obesity and tobacco use). This area holds much potential for gaining an understanding about allocation of resources in Louisiana in heart failure care and as a consequence to policy development for standardized patient treatment and improved care.