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Bolt L, Wertli MM, Haynes AG, Rodondi N, Chiolero A, Panczak R, Aujesky D. Variation in regional implantation patterns of cardiac implantable electronic device in Switzerland. PLoS One 2022; 17:e0262959. [PMID: 35171922 PMCID: PMC8849475 DOI: 10.1371/journal.pone.0262959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction There is a substantial geographical variation in the rates of pacemaker (PM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT) device implantation across European countries. We assessed the extent of regional variation and potential determinants of such variation. Methods We conducted a population-based analysis using discharge data for PM/ICD/CRT implantations from all Swiss acute care hospitals during 2013–2016. We derived hospital service areas (HSA) by analyzing patient flows. We calculated age- and sex-standardized rates and quantified variation using the extremal quotient (EQ) and the systemic component of variation (SCV). We estimated the reduction in variance of crude implantation rates across HSAs using multilevel regression models, with incremental adjustment for age and sex, language, socioeconomic factors, population health, diabetes mellitus, and the density of cardiologists on the HSA level. Results We analyzed implantations of 8129 PM, 1461 ICD, and 1411 CRT from 25 Swiss HSAs. The mean age- and sex-standardized implantation rate was 29 (range 8–57) per 100,000 persons for PM, 5 (1–9) for ICD, and 5 (2–8) for CRT. There was a very high variation in PM (EQ 7.0; SCV 12.6) and ICD (EQ 7.2; SCV 11.3) and a high variation in CRT implantation rates (EQ 3.9; SCV 7.1) across HSAs. Adjustments for age and sex, language, socioeconomic factors, population health, diabetes mellitus, and density of cardiologists explained 94% of the variance in ICD and 87.5% of the variance in CRT implantation rates, but only 36.3% of the variance in PM implantation rates. Women had substantially lower PM/ICD/CRT implantation rates than men. Conclusion Switzerland has a very high regional variation in PM/ICD implantation and a high variation in CRT implantation rates. Women had substantially lower implantation rates than men. A large share of the variation in PM procedure rates remained unexplained which might reflect variations in physicians’ preferences and practices.
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Affiliation(s)
- Lucy Bolt
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria M. Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| | | | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
- School of Population and Global Health, McGill University, Montreal, Canada
| | - Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Kimiaeimehr F, Hosseini SM, Alimohammadzadeh K, Bahadori M, Maher A. Confirmatory factor analysis model of factors affecting the implementation of clinical guidelines in Iran. Med J Islam Repub Iran 2020; 34:122. [PMID: 33437718 PMCID: PMC7787019 DOI: 10.34171/mjiri.34.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Indexed: 11/05/2022] Open
Abstract
Background: Clinical guidelines refer to a developed scientific statement to help physicians and patients for decision-making about the best care for special clinical conditions, which can be an important document to shape evidence-based medicine. This study aimed to identify factors affecting the implementation of clinical guidelines in Iran to enhance the quality of services. Methods: This descriptive analytical study was performed with combined quantitative-qualitative method in the first half of 2019. The statistical population consisted of 400 health managers and experts who were selected through multistage sampling method in 5 regions of Iran (north, south, center, east, and west). Overall, 20 academic experts were selected from each university. For data collection, a researcher-made questionnaire (n = 400) was used. To measure face and content validity, content validity ratio (CVR) and content validity index (CVI) were used. Also, to determine reliability, test-retest method, with Cronbach's alpha coefficient of 0.934 was used. For data analysis, Lisrel 8.8 and SPSS 24 were used. Finally, fitness indices were used to determine the fitness of the model. Results: Six factors, including organizational (9 components), organizational culture (8 components), the clinical guidelines feature (8 components), insurance (7 components), and trusteeship of the health care system (8 components) were identified as the main dimensions. The economic dimension had the maximum effect on implementing clinical guidelines (0.90), while the clinical guidelines feature (0.63) and organizational culture (0.63) showed the minimum extent of effect on implementing clinical guidelines. Conclusion: Evidently, imposing the mentioned interventions with the ultimate goal of sustainable behavior change in providing health care services requires contribution of all practitioners, presentation of suitable facilities for implementing clinical guidelines based on evidence, time and personnel management, training methodology and planning, developing the necessary infrastructure, supervision, and developing professional and legal motivation.
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Affiliation(s)
- Farzaneh Kimiaeimehr
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Khalil Alimohammadzadeh
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
- Health Economics Policy Research Center, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Maher
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
- Department of Health Policy, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mistry A, Vali Z, Taher A, Sidhu B, Li X, Newton M, Ng GA. Consideration for primary prevention implantable cardioverter defibrillators differ between specialities. Postgrad Med J 2019; 95:205-209. [PMID: 31097576 DOI: 10.1136/postgradmedj-2019-136447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/18/2019] [Accepted: 05/04/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE Implantable cardioverter defibrillator (ICD) implantation rates remain variable despite established guideline recommendations. This study aims to assess whether being managed by a cardiologist has an impact on whether patients are considered for an ICD for primary prevention of sudden cardiac death. DESIGN/METHODS Single-centre, retrospective, observational study of patients identified to have severe left ventricular systolic dysfunction (LVSD) on echocardiography (n = 129) between 1 and 30 June 2016 with cross-sectional assessment at 1 year. An assessment of ICD consideration at 1 year following the echocardiogram was documented, in addition to the specialty of the managing physician (group 1-electrophysiologist/heart failure specialist; group 2-all other cardiologists; group 3-non-cardiologist). RESULTS 129/1173 (11%) transthoracic echocardiographies (s) were identified to have severe LVSD. 52 (40%), 37 (29%) and 40 (31%) were managed by group 1, group 2 and group 3, respectively. Mean age was 74.7 (±12.6) years with a predominance of male gender (70.5%). An ICD was not considered in 47.3%. Those managed by a cardiologist were more likely to be considered for an ICD than a non-cardiologist (63.9% vs 30.0%; OR 4.0, 95% CI 1.8 to 8.8, p = 0.001) with a greater survival at 1 year (89.9% vs 52.5%, OR 8.1 95% CI 3.2 to 20.4, p < 0.001). Group 1 were more likely to consider ICD than group 2 cardiologists (75.0% vs 45.9%; OR 3.5; 95% CI 1.4 to 8.7, p = 0.005). CONCLUSION There is significant variation between cardiologists and non-cardiologists, as well as within different cardiology subspecialists, when considering the option of ICD therapy for primary prevention.
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Affiliation(s)
- Amar Mistry
- Department of Cardiovascular Science, University of Leicester, Leicester, UK .,Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - Zakariyya Vali
- Department of Cardiovascular Science, University of Leicester, Leicester, UK.,Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - Abu Taher
- Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - Bharat Sidhu
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - Xin Li
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - Michelle Newton
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - Ghulam Andre Ng
- Department of Cardiovascular Science, University of Leicester, Leicester, UK.,Department of Cardiology, Glenfield Hospital, Leicester, UK
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Torbica A, Banks H, Valzania C, Boriani G, Fattore G. Investigating Regional Variation of Cardiac Implantable Electrical Device Implant Rates in European Healthcare Systems: What Drives Differences? HEALTH ECONOMICS 2017; 26 Suppl 1:30-45. [PMID: 28139088 DOI: 10.1002/hec.3470] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/27/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
Despite established efficacy for cardiac implantable electrical devices (CIEDs), large differences in CIED implant rates have been documented across and within countries. The aim of this paper is to investigate the influence of socio-economic, epidemiological and supply side factors on CIED implant rates across 57 Regions in 5 EU countries and to assess the feasibility of using administrative data for this purpose. A total of 1 330 098 hospitalizations for CIED procedures extracted from hospital discharge databases in Austria, England, Germany, Italy and Slovenia from 2008 to 2012 was used in the analysis. Higher levels of tertiary education among the labour force and percent of aged population are positively associated with implant rates of CIED. Regional per capita GDP and number of implanting centres appear to have no significant effect. Institutional factors are shown to be important for the diffusion of CIED. Wide variation in CIED implant rates across and within five EU countries is undeniable. However, regional factors play a limited part in explaining these differences with few exceptions. Administrative databases are a valuable source of data for investigating the diffusion of medical technologies, while the choice of appropriate modelling strategy is crucial in identifying the drivers for variation across countries. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Aleksandra Torbica
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Helen Banks
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Cinzia Valzania
- Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Boriani
- Modena University Hospital, Universita degli Studi di Modena e Reggio Emilia Facolta di Medicina e Chirurgia, Modena, Italy
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Raatikainen MP, Arnar DO, Merkely B, Camm AJ, Hindricks G. Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association. Europace 2016; 18 Suppl 3:iii1-iii79. [DOI: 10.1093/europace/euw244] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/13/2022] Open
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Valzania C, Torbica A, Tarricone R, Leyva F, Boriani G. Implant rates of cardiac implantable electrical devices in Europe: A systematic literature review. Health Policy 2015; 120:1-15. [PMID: 26632502 DOI: 10.1016/j.healthpol.2015.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 10/02/2015] [Accepted: 11/02/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND In recent years, indications for cardiac implantable electrical devices (CIEDs) have broadened; however, budget constraints can significantly impact patient access to these life-saving health technologies. OBJECTIVE To perform a systematic literature review on the implant rates of pacemakers, cardioverter-defibrillators, and cardiac resynchronization therapy devices in Europe over the last decade to provide insight into the possible reasons for differences across regions or countries. METHODS Four electronic databases were searched to find studies describing CIED implant rates in Europe. Fifty-eight studies were included. RESULTS An overview showed a recent rise in CIED implants, with large geographic differences. The ratio between the regions with the highest and lowest implant rates within the same country ranged between 1.3 and 3.4 for pacemakers and between 1.7 and 44.0 for defibrillators. The ratio between the countries with the highest and lowest implant rates ranged between 2.3 and 87.5 for pacemakers, between 3.1 and 1548.0 for defibrillators, and between 4.1 and 221.0 for resynchronization therapy devices. Implant rate variability appears to be influenced by health care, economic, demographic, and cultural factors. CONCLUSION Publications on CIED implant rates in Europe show a wide variability within and across countries, the determinants of which are only partially investigated. Policy making should improve regarding equity of access to better care.
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Affiliation(s)
- Cinzia Valzania
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Aleksandra Torbica
- CERGAS, Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Rosanna Tarricone
- CERGAS, Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Francisco Leyva
- Aston Medical Research Institute, Aston University Medical School, Birmingham, United Kingdom
| | - Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy; Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena , Modena, Italy
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Raatikainen MP, Arnar DO, Zeppenfeld K, Merino JL, Kuck KH, Hindricks G. Current trends in the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology member countries: 2015 report from the European Heart Rhythm Association. Europace 2015; 17 Suppl 4:iv1-72. [DOI: 10.1093/europace/euv265] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Raatikainen MJP, Arnar DO, Zeppenfeld K, Merino JL, Levya F, Hindriks G, Kuck KH. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace 2015; 17 Suppl 1:i1-75. [DOI: 10.1093/europace/euu300] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sadeghi-Bazargani H, Tabrizi JS, Azami-Aghdash S. Barriers to evidence-based medicine: a systematic review. J Eval Clin Pract 2014; 20:793-802. [PMID: 25130323 DOI: 10.1111/jep.12222] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. METHODS Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. RESULTS Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. CONCLUSION The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled.
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Boriani G, Berti E, Belotti LMB, Biffi M, Carboni A, Bandini A, Casali E, Tomasi C, Toselli T, Baraldi P, Bottoni N, Barbato G, Sassone B. Cardiac resynchronization therapy: implant rates, temporal trends and relationships with heart failure epidemiology. J Cardiovasc Med (Hagerstown) 2014; 15:147-54. [PMID: 23811841 DOI: 10.2459/jcm.0b013e3283638d90] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Consensus guidelines define indications for cardiac resynchronization therapy (CRT), but the variability in implant rates in 'real world' clinical practice, as well as the relationship with the epidemiology of heart failure are not defined. METHODS AND RESULTS In Emilia-Romagna, an Italian region with around 4.4 million inhabitants, a registry was instituted to collect data on implanted devices for CRT, with (CRT-D) or without defibrillation (CRT-P) capabilities. Data from all consecutive patients resident in this region who underwent a first implant of a CRT device in years 2006-2010 were collected and standardized (considering each of the nine provinces of the region). The number of CRT implants increased progressively, with a 71% increase in 2010 compared to 2006. Between 84 and 90% of implants were with CRT-D devices. The variability in standardized implant rates among the provinces was substantial and the ratio between the provinces with the highest and the lowest implant rates was always greater than 2. Considering prevalent cases of heart failure in the period 2006-2010, the proportion of patients implanted with CRT per year ranged between 0.23 and 0.30%. CONCLUSIONS The application in 'real world' clinical practice of CRT in heart failure is quite heterogeneous, with substantial variability even among areas belonging to the same region, with the need to make the access to this treatment more equitable. Despite the increased use of CRT, its overall rate of adoption is low, if a population of prevalent heart failure patients is selected on the basis of administrative data on hospitalizations.
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Affiliation(s)
- Giuseppe Boriani
- aInstitute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi bAgency for Health and Social Care of Emilia-Romagna, Bologna cDivision of Cardiology, Parma dDivision of Cardiology, Forli' eDivision of Cardiology, Modena fDivision of Cardiology, Ravenna gDivision of Cardiology, Ferrara hDivision of Cardiology, Baggiovara (MO) iDivision of Cardiology, Reggio Emilia jDivision of Cardiology, Maggiore Hospital, Bologna kOspedale SS Annunziata Cento, AUSL Ferrara, Cento (FE), Italy
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Narayanan K, Reinier K, Uy-Evanado A, Teodorescu C, Chugh H, Marijon E, Gunson K, Jui J, Chugh SS. Frequency and determinants of implantable cardioverter defibrillator deployment among primary prevention candidates with subsequent sudden cardiac arrest in the community. Circulation 2013; 128:1733-8. [PMID: 24048201 DOI: 10.1161/circulationaha.113.002539] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence rates and influencing factors for deployment of primary prevention implantable cardioverter defibrillators (ICDs) among subjects who eventually experience sudden cardiac arrest in the general population have not been evaluated. METHODS AND RESULTS Cases of adult sudden cardiac arrest with echocardiographic evaluation before the event were identified from the ongoing Oregon Sudden Unexpected Death Study (population approximately 1 million). Eligibility for primary ICD implantation was determined from medical records based on established guidelines. The frequency of prior primary ICD implantation in eligible subjects was evaluated, and ICD nonrecipients were characterized. Of 2093 cases (2003-2012), 448 had appropriate pre- sudden cardiac arrest left ventricular ejection fraction information available. Of these, 92 (20.5%) were eligible for primary ICD implantation, 304 (67.9%) were ineligible because of left ventricular ejection fraction >35%, and the remainder (52, 11.6%) had left ventricular ejection fraction ≤35% but were ineligible on the basis of clinical guideline criteria. Among eligible subjects, only 12 (13.0%; 95% confidence interval, 6.1%-19.9%) received a primary ICD. Compared with recipients, primary ICD nonrecipients were older (age at ejection fraction assessment, 67.1±13.6 versus 58.5±14.8 years, P=0.05), with 20% aged ≥80 years (versus 0% among recipients, P=0.11). Additionally, a subgroup (26%) had either a clinical history of dementia or were undergoing chronic dialysis. CONCLUSIONS Only one fifth of the sudden cardiac arrest cases in the community were eligible for a primary prevention ICD before the event, but among these, a small proportion (13%) were actually implanted. Although older age and comorbidity may explain nondeployment in a subgroup of these cases, other determinants such as socioeconomic factors, health insurance, patient preference, and clinical practice patterns warrant further detailed investigation.
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Affiliation(s)
- Kumar Narayanan
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (K.N., K.R., A.U.-E., C.T., H.C., E.M., S.S.C.); and Departments of Pathology (K.G.) and Emergency Medicine (J.J.), Oregon Health and Science University, Portland, OR
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Boriani G, Maniadakis N, Auricchio A, Muller-Riemenschneider F, Fattore G, Leyva F, Mantovani L, Siebert M, Willich SN, Vardas P, Kirchhof P. Health technology assessment in interventional electrophysiology and device therapy: a position paper of the European Heart Rhythm Association. Eur Heart J 2013; 34:1869-1874. [DOI: 10.1093/eurheartj/eht031] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Assessing the outcomes of implantable cardioverter defibrillator treatment in a real world setting: results from hospital record data. BMC Health Serv Res 2013; 13:100. [PMID: 23496994 PMCID: PMC3602059 DOI: 10.1186/1472-6963-13-100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 03/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A plethora of clinical studies have assessed the benefits of implantable cardioverter defibrillators (ICDs) and supported their use in clinical practice. However, evidence on the safety and efficacy of ICDs appears insufficient to support expansion of their use in clinical practice, and more information on their impact in real life settings is warranted. This paper aims to investigate the impact of ICDs using a large administrative dataset reflecting actual clinical practice. METHODS Data were obtained from the hospital discharge database of the Friuli Venezia Giulia region in Italy containing patient-level information on 169,488 cases. Data on mortality outside hospital were obtained from regional sources. Exact matching method was used to estimate the outcomes associated with ICDs: mortality, length of stay, re-hospitalization and regional expenditure. The method was applied in two steps. First, patients with ICDs were matched with those without using the following: age class (by 5 years), gender, year of admission, type of admission (day hospital vs. ordinary) and primary diagnosis. In the second step, matching included also Charlson Comorbidities Index. Exact matching average treatment effect on the treated (ATT) was used as a main measure of impact. RESULTS Compared with matched controls, treatment with ICDs was associated with lower mortality (absolute risk reduction 10.6% at 1 year and 8.3% at 2 and 8.4% at 3 years, p < 0.001 and hazard ratio 0.80, p < 0.001), greater regional expenditure at index hospitalization (ATT: €9459.64, p < 0.001) and during follow up (ATT: €1707.29, p < 0.001) and higher re-hospitalization rate (ATT: 0.53, p < 0.001). No significant difference was found for length of stay (9.07 vs. 8.86 days). The results were maintained after more restrictive matching was applied. CONCLUSIONS Assessing the impact of innovative, expensive medical technologies on the basis of real world data is warranted, especially when there are barriers to implementation. Hospital administrative datasets can be of great value when a technology such as the ICD is implemented in a relatively small sample of patients, to allow use of exact matching techniques.
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Arribas F, Auricchio A, Wolpert C, Merkely B, Merino JL, Boriani G, van der Velde E, Camm J, Vardas P. The EHRA White Book. ACTA ACUST UNITED AC 2012; 14 Suppl 3:iii1-55. [DOI: 10.1093/europace/eus256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Parkash R, Sapp JL, Basta M, Doucette S, Thompson K, Gardner M, Gray C, Brownell B, Kidwai H, Cox J. Use of Primary Prevention Implantable Cardioverter-Defibrillators in a Population-Based Cohort Is Associated With a Significant Survival Benefit. Circ Arrhythm Electrophysiol 2012; 5:706-13. [DOI: 10.1161/circep.112.970798] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ratika Parkash
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John L. Sapp
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Magdy Basta
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steve Doucette
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kara Thompson
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Gardner
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris Gray
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brenda Brownell
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hena Kidwai
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jafna Cox
- From the Department of Medicine, Queen Elizabeth II Health Sciences Center (R.P., J.L.S., M.B., K.T., M.G., C.G., B.B., H.K., J.C.) and the Department of Community Health and Epidemiology (S.D.), Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada
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16
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Boriani G, Gardini B, Diemberger I, Reggiani MLB, Biffi M, Martignani C, Ziacchi M, Valzania C, Gasparini M, Padeletti L, Branzi A. Meta‐analysis of randomized controlled trials evaluating left ventricular vs. biventricular pacing in heart failure: effect on all‐cause mortality and hospitalizations. Eur J Heart Fail 2012; 14:652-660. [DOI: 10.1093/eurjhf/hfs040] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | | | | | | | - Mauro Biffi
- Institute of Cardiology University of Bologna Bologna Italy
| | | | - Matteo Ziacchi
- Institute of Cardiology University of Bologna Bologna Italy
| | | | - Maurizio Gasparini
- Electrophysiology and Pacing Unit, Cardiology Department IRCCS Istituto Clinico Humanitas Rozzano Milano Italy
| | - Luigi Padeletti
- Department of Heart and Vessels University of Florence Florence Italy
| | - Angelo Branzi
- Institute of Cardiology University of Bologna Bologna Italy
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17
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Prophylactic cardioverter defibrillator utilization in the ?real world?: A conundrum. Int J Cardiol 2012; 156:123-4. [DOI: 10.1016/j.ijcard.2011.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/18/2011] [Indexed: 11/19/2022]
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18
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Guerra J, Bagur C, Girabent M. Adaptación al castellano y validación del cuestionario sobre práctica basada en la evidencia en fisioterapeutas. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.ft.2011.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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19
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Podczeck-Schweighofer A. European utilization of ICD/CRT-therapy. Interv Med Appl Sci 2011. [DOI: 10.1556/imas.3.2011.3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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