Implantable cardioverter defibrillators (ICDs) for primary prevention in community practice: clinical characteristics, outcomes, resource utilization, and cost
Co-Principal Investigators: Robert T. Greenlee, PhD & Frederick Masoudi, MD, MSPH
Implantable cardioverter defibrillators (ICDs) have revolutionized the approach to treatment for patients with left ventricular systolic dysfunction, who are at risk for sudden cardiac death. These devices deliver therapies (either anti-tachycardia pacing or high energy shocks) to treat malignant ventricular arrhythmias. ICDs may also deliver therapies inappropriately, which can have adverse consequences for patients. Most existing data on the complication rates around the time of ICD placement and longer-term outcomes (including mortality, morbidity, and ICD therapies) derive from clinical trials, which enroll subjects who may not be representative of patients cared for in routine practice. This project is a retrospective cohort of more than 3,500 patients receiving an ICD for the primary prevention of sudden cardiac death between 2006 and 2010 in seven health plans. The aims of this project are: 1) to evaluate the extent to which patients receiving ICDs for primary prevention meet guideline-based eligibility criteria; 2) to assess longitudinal outcomes, including complications, mortality, and mortality among primary prevention ICD patients compared to published trial results; 3) to characterize the frequency of ICD therapies using an adjudicated database of ICD therapies; and 4) to identify the characteristics associated with complications, mortality, morbidity, and ICD therapies in real world community practice. The findings of this study will inform patients, clinicians, and policy-makers about the outcomes of this therapy in a real-world patient population.
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