Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients with Low Ejection Fraction after Myocardial Infarction

• Published in: Circulation (New York, N.Y.) N.Y.), 2017-01, Vol.135 (1), p.38-47
• Main Authors: Pokorney, Sean D, Miller, Amy L, Chen, Anita Y, Thomas, Laine, Fonarow, Gregg C, de Lemos, James A, Al-Khatib, Sana M, Velazquez, Eric J, Peterson, Eric D, Wang, Tracy Y
• Format: Article
• Language: English
• Subjects: Aged; Databases, Factual; Defibrillators, Implantable; Female; Heart Ventricles - diagnostic imaging; Humans; Magnetic Resonance Imaging; Male; Medicare; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocardial Revascularization; Proportional Hazards Models; Registries; Retrospective Studies; Stroke Volume; Survival Rate; Tomography, X-Ray Computed; Ultrasonography; United States
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.116.022359

BACKGROUND—Guidelines recommend that patients with low ejection fractions (EF) post-myocardial infarction (MI) have their EF reassessed 40 days after MI for implantable cardioverter-defibrillator (ICD) candidacy. This study examines rates of EF reassessment and their association with 1-year ICD implantation in post-MI patients with low EF. METHODS—We examined rates of post-discharge EF reassessment and ICD implantation among 10,289 Medicare-insured patients ≥65 years with an EF≤35% during the index MI admission from 1/2007–9/2010 in ACTION Registry–GWTG. Multivariable Cox models tested the association between time-dependent EF reassessment and 1-year ICD implantation, stratified by revascularization status during the index MI admission. RESULTS—Among patients with EF≤35% during the index MI admission, 66.8% (95% CI 65.9%-67.8%) had EF reassessment within the next year. Revascularized patients were more likely to have EF reassessment (76.9% [95% CI 75.8%-78.0%)] vs. 53.7% [95% CI 52.2%-55.2%], p