1. Trends and predictors of implantable cardioverter defibrillator implantation after sudden cardiac arrest: Insight from the national inpatient sample
- Author
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Fahad Alqahtani, Muhammad Bilal Munir, Sami Aljohani, Sujal Modi, Mohamad Alkhouli, and Ashwin Bhirud
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Survivors ,030212 general & internal medicine ,education ,Aged ,education.field_of_study ,business.industry ,Sudden cardiac arrest ,General Medicine ,Middle Aged ,medicine.disease ,Implantable cardioverter-defibrillator ,United States ,Defibrillators, Implantable ,Ventricular flutter ,Death, Sudden, Cardiac ,Ventricular fibrillation ,Cardiology ,Etiology ,Female ,Implant ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Implantable cardioverter defibrillator (ICD) has a class IA indication in survivors of sudden cardiac arrest (SCA) provided no reversible cause is identified. We sought to determine trends and predictors of ICD implant in SCA patients from a national sample of the United States population. Methods and results Data were gathered from National Inpatient Sample (NIS) from January 2003 to December 2014. All patients ≥18 years of age with a primary discharge diagnosis of SCA, ventricular fibrillation (VF), ventricular flutter, and ventricular tachycardia (VT) were included. Patients died during hospitalization, had a previous ICD implant, and with a reversible cause of SCA were excluded. Primary outcome of interest was rate of new ICD implant at discharge. Logistic regression analysis was then performed to determine predictors for ICD implantation. A total of 176,876 patients were identified to have SCA, VF, ventricular flutter, and VT. After applying exclusion criteria, we were left with 22,054 patients. Out of this, 6,908 (31%) patients were implanted with an ICD prior to discharge. There was a linear trend toward reduced ICD utilization over our study period (40% in 2003 vs 25% in 2014, P trend = 0.0004). Advanced age, black race, and chronic renal disease are independently associated with low ICD utilization. Conclusion We found low trend of ICD implant in survivors of SCA without any reversible cause. There is a need to identify etiologies behind low ICD utilization in this vulnerable group who are at most risk for a subsequent SCA.
- Published
- 2018