Abstract P110: Medicare/Medicaid Patients are at Increased Risk for Death after Prophylactic Implantable Cardioverter-Defibrillator Implantation

Abstract

Background: If reliable predictors of mortality after prophylactic implantable cardioverter-defibrillator (ICD) implantation were identified, this information could be used to target this therapy to patients (pts) who are most likely to benefit. Methods: The study population consisted of 584 pts who received an ICD for primary prevention from 3/06 to 12/09 at a single center. Clinical and demographic variables were obtained from the ACC-NCDR ICD Registry data. Vital status was obtained from clinic records and the Social Security Death Index. Univariate and multivariable Cox analysis were used to identify significant predictors of mortality. Results: The pts were 76% male with mean age 69±13 yrs. There were 89 deaths after 590±400 days of follow-up. Insurance type was a significant predictor of mortality (p=0.015, figure). Pts with Medicare/Medicaid (M) had more high risk features such as older age, worse renal function, more advanced heart failure, prior stroke, prior bypass surgery, and were more likely to receive biventricular ICDs. After adjustment for these factors, M was independently associated with decreased survival as compared to Commercial (adjusted HR 0.26, p=0.005) but not Health Maintenance Organization (HMO, adjusted HR 0.69, p=0.24). Conclusions: M insurance is independently associated with increased mortality after prophylactic ICD implantation. Additional research is needed to determine if this finding is attributable to quality of care or decreased access to medical services.