Infrequent physician use of implantable cardioverter-defibrillators presents potential risks to patient safety
Research Activities, July 2012, No. 383
Implantable cardioverter-defibrillators (ICDs) are used to treat a variety of heart conditions. They detect dangerous rhythm disturbances and can quickly return the heart back to normal rhythm. Their growing use and popularity over the years, however, may be posing potential safety risks to patients, particularly when inexperienced clinicians implant them, concludes a new study. It found that a majority of physicians implant on average one or fewer ICDs per year, which were linked to higher mortality and complication levels.
Researchers reviewed admission data in New York State to identify all ICD implantations from 1997 to 2006. Each patient was followed for 90 days and again at 1 year to determine if they experienced any subsequent hospital admissions. Specifically, the researchers looked to see how many ICDs were being implemented by physicians, 90-day complication rates, and if patients died or needed adjustments within 1 year.
During the study period, 38,992 ICDs were implanted. From 1997 to 2006, the number of these procedures nearly tripled. Out of 2,080 physicians performing these procedures, 73.4 percent were deemed "very-low-volume" physicians in that they implanted 1 or fewer ICDs each year. This group of physicians performed 11 percent of all implantations. The overall complication rate was 16.5 percent and the 90-day mortality rate was 2.8 percent. However, patients treated by very-low-volume physicians were more likely to die and nearly five times more likely to suffer cardiac complications than patients receiving implants from more experienced physicians. Patients treated at higher-volume hospitals had a lower risk of readmission and all-cause mortality within 90 days and a lower risk of revision surgery within 1 year. The study was supported in part by the Agency for Healthcare Research and Quality (HS16075).
See "Infrequent physician use of implantable cardioverter-defibrillators risks patient safety," by Stephen Lyman, Ph.D., Art Sedrakyan, M.D., Ph.D., Huong Do, M.S., and others in Heart 97, pp. 1655-1660, 2011.