背景:适当的使用标准(AUC)是一组不同的适应症,旨在更好地评估ICD和CRT治疗的益处。
目的:量化ICD和CRT-D植入物的比例,也许合适(MA),或根据AUC指南很少合适(RA)。
方法:多中心,回顾性研究2018年4月至2019年3月在美国>1500家医院接受ICD植入的NCDR内患者。使用AUC判定ICD植入物的适当性。
结果:在309,318个ICD中,主要植入物为241,438(78.1%),二级预防植入物为67,880(21.9%);80%可映射到AUC。对于一级预防,185,431个ICD(96.4%)是合适的,5,660(2.9%)MA,和1,205(0.6%)RA。二级预防,47,498个ICD(92.7%)是合适的,2,581(5%)MA,和1,157(2.3%)RA。NYHAIV级HF患者中发生了大量RA植入物,不符合晚期治疗(53.9%)和40天内MI患者(18.1%)。起搏导线的适当性变化较大,48,470(62%)的双腔ICD植入物被分类为适当的,29,209(37.4%)MA和448(0.6%)RA。在CRT-D植入物中,63848(82.2%)是合适的,9,900(12.7%)MA和3,940(5.1%)RA用于LV起搏。99,754个植入物被认为是适当的,但被排除在CMS国家覆盖率确定(NCD)之外。超过92%的医院RA植入率<4%。
结论:在这个大型国家注册中心中,95%的可映射ICD和CRT-D植入物被认为是合适的,<2%的很少合适的植入物。CMS\'NCD排除了近100,000个适当的植入物。
BACKGROUND: The appropriate use criteria (AUCs) are a diverse group of indications aimed to better evaluate the benefits of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy.
OBJECTIVE: The purpose of this study was to quantify the proportion of ICD and cardiac resynchronization therapy with defibrillator (CRT-D) implants as appropriate, may be appropriate (MA), or rarely appropriate (RA) on the basis of the AUC guidelines.
METHODS: This is a multicenter retrospective study of patients within the National Cardiovascular Data Registry undergoing ICD implantation between April 2018 and March 2019 at >1500 US hospitals. The appropriateness of ICD implants was adjudicated using the AUC.
RESULTS: Of 309,318 ICDs, 241,438 were primary prevention implants (78.1%) and 67,880 secondary prevention implants (21.9%); 243,532 (79%) were mappable to the AUC. For primary prevention, 185,431 ICDs (96.4%) were appropriate, 5660 (2.9%) MA, and 1205 (0.6%) RA. For secondary prevention, 47,498 ICDs (92.7%) were appropriate, 2581 (5%) MA, and 1157 (2.3%) RA. A significant number of RA devices were implanted in patients with New York Heart Association class IV heart failure who were ineligible for advanced therapies (53.9%) and those with myocardial infarction within 40 days (18.1%). The appropriateness of the pacing lead was more variable, with 48,470 dual-chamber ICD implants (62%) being classified as appropriate, 29,209 (37.4%) MA, and 448 (0.6%) RA. Among CRT-D implants, 63,848 (82.2%) were appropriate, 9900 (12.7%) MA, and 3940 (5.1%) RA for left ventricular pacing. A total of 99,754 implants were deemed appropriate but excluded from Centers for Medicare & Medicaid Services National Coverage Determination. More than 92% of hospitals had an RA implant rate of <4%.
CONCLUSIONS: In this large national registry, 95% of mappable ICD and CRT-D implants were considered appropriate, with <2% of RA implants. Nearly 100,000 appropriate implants are excluded by Centers for Medicare & Medicaid Services National Coverage Determination.