Utilization and in-hospital complications of cardiac resynchronization therapy: trends in the United States from 2003 to 2013

Hosseini, Seyed Ali; Moazzami, Kasra; Rozen, Guy; Vaid, Jeena; Saleh, Ahmed; Heist, E. Kevin; Vangel, Mark; Ruskin, Jeremy N.

doi:10.1093/eurheartj/ehx100

Cited by 50 publications

(44 citation statements)

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“…Women accounted for 29.9% of all patients undergoing any type of CRT implantation, meaning that 79.2% of women received CRT-Ds compared with 87.5% of men (or, conversely, that 20.8% of women received CRT-Ps compared with 12.5% of men). The fact that >70% of all CRT devicesdand of CRT-Ds, specificallydwere implanted in men gives one pause for thought but was described in more detail in a previous report by the same authors 9 and has been observed in other studies, including in similar analyses using the NIS, 10,11 and in other countries. 12 Rather, the current analysis is focused on relative differences between the sexes in the type of CRT device implanted.…”

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confidence: 80%

Sex Differences in Cardiac Resynchronization Therapy Device Implantations and Complications: Tough Questions, Tougher Answers

Ramirez

2021

Canadian Journal of Cardiology

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confidence: 80%

Sex Differences in Cardiac Resynchronization Therapy Device Implantations and Complications: Tough Questions, Tougher Answers

Ramirez

2021

Canadian Journal of Cardiology

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“…The chi-square (χ2) test and Wilcoxon rank sum test were used to compare categorical variables and continuous variables, respectively. The NIS provided discharge sample weights that were calculated within each sampling stratum as the ratio of discharges in the universe to discharges in the sample (25). Prior to 2012, a 20% sample from all hospitals in the United States providing long-term acute care and 100% discharge data from these hospitals were retained.…”

Section: Discussionmentioning

confidence: 99%

Comparing Trajectory of Surgical Aortic Valve Replacement in the Early vs. Late Transcatheter Aortic Valve Replacement Era

Elbaz‐Greener

Rozen

Kusniec

et al. 2021

Front. Cardiovasc. Med.

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Background: Traditionally, the only effective treatment for aortic stenosis was surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011 and provided a critical alternative therapy. Our aims were to investigate the trends in the utilization of SAVR in the early vs. late TAVR era and to assess SAVR and TAVR outcomes.Methods: Using the 2011–2017 National Inpatient Sample database, we identified hospitalizations for patients with a most responsible diagnosis of aortic stenosis during which an aortic valve replacement (AVR) was performed, either SAVR or TAVR. Patients' sociodemographic and clinical characteristics, procedure complications, length of stay, and mortality were analyzed. Multivariable analyses were performed to identify predictors of in-hospital mortality. Piecewise regression analyses were performed to assess temporal trends in SAVR and TAVR utilization.Results: A total of 542,734 AVR procedures were analyzed. The utilization of SAVR was steady until 2014 with a significant downward trend in the following years 2015–2017 (P = 0.026). In contrast, a steady upward trend was observed in the TAVR procedure with a significant increase during the years 2015–2017 (P = 0.006). Higher in-hospital mortality was observed in SAVR patients. The mortality rate declined from 2011 to 2017 in a significantly higher proportion in the TAVR compared with the SAVR group.Conclusion: Utilization of SAVR showed a downward trend during the late TAVR era (2015–2017), and TAVR utilization demonstrated a steady upward trend during the years 2011–2017. Higher in-hospital mortality was recorded in patients who underwent SAVR.

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“…Moreover, some observational studies have analyzed the utilization of CRT devices in various patient groups [77][78][79][80][81] but few have connected the utilization patterns with changes in guidelines in a wider setting [82]. One study has observed the evolution of guidelines as an underlying reason for increased pharmaceutical utilization in the US [83].…”

Section: Discussionmentioning

confidence: 99%

Impact of Guidelines on the Diffusion of Medical Technology: A Case Study of Cardiac Resynchronization Therapy in the UK

Vadia

Stargardt²

2020

Appl Health Econ Health Policy

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Introduction Research on clinical practice guidelines as a determinant of the diffusion of medical technology remains sparse. We aim to evaluate the impact of guidelines on the awareness of medical technology, as a proxy of its use, with the example of cardiac resynchronization therapy (CRT) in the United Kingdom (UK). Methods We measured clinician awareness based on Google searches performed for CRT that corresponded with actual CRT implant numbers provided by the European Heart Rhythm Association (EHRA). We identified the guideline recommendations published by the National Institute of Health and Care Excellence (NICE) within the UK, the European Society of Cardiology (ESC) at the European level, and the American College of Cardiology Foundation/American Heart Association in the United States (US). We specified a dynamic moving average model, with Google searches as the dependent variable and guideline changes as the independent variables. Results One guideline change published by NICE in 2007 and two changes released by the US guidelines in 2005 and 2012 were significantly correlated with the Google searches (p = 0.08, p = 0.02, and p = 0.02, respectively). Guideline changes by the ESC had no significant impact. Changes recommending CRT in place of a conventional pacemaker, in patients with atrial fibrillation, and restricting CRT due to contraindication, remained universally uninfluential. Conclusion The factors associated with a lack of awareness (as a proxy for technology diffusion) in our case study were: a lack of strong clinical evidence that resulted in the moderate strength of a recommendation, a lack of recognition of any externally published recommendation by NICE, and the frequent release of guidelines with minor changes targeting small patient groups. At least in our case, in the absence of NICE guidelines, the US guidelines received more attention than their non-UK European counterparts, even if the former were released after the latter.

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Utilization and in-hospital complications of cardiac resynchronization therapy: trends in the United States from 2003 to 2013

Abstract: From 2003 to 2013, the severity of comorbid conditions increased and a rising trend was observed in the rate of periprocedural complications among patients undergoing CRT in the United States. In-hospital mortality and length of stay showed no uniform trend.

Cited by 50 publications

References 33 publications

Sex Differences in Cardiac Resynchronization Therapy Device Implantations and Complications: Tough Questions, Tougher Answers

Sex Differences in Cardiac Resynchronization Therapy Device Implantations and Complications: Tough Questions, Tougher Answers

Comparing Trajectory of Surgical Aortic Valve Replacement in the Early vs. Late Transcatheter Aortic Valve Replacement Era

Impact of Guidelines on the Diffusion of Medical Technology: A Case Study of Cardiac Resynchronization Therapy in the UK

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