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

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 impl...

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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
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cited_by cdi_FETCH-LOGICAL-c4229-f658c7d8f34f3b752b50ac0b844bf0d0d954ba920fcefdcf9b4b7574629585d53
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container_issue 1
container_start_page 38
container_title Circulation (New York, N.Y.)
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creator 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
description 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
doi_str_mv 10.1161/CIRCULATIONAHA.116.022359
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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 &lt;0.001) and had shorter times to EF reassessment (median 67 vs. 84 days, p&lt;0.001) than non-revascularized patients. Among patients with EF reassessment, only 11% received an ICD within 1 year. Reassessment of EF was associated with higher likelihood of ICD implantation for both revascularized (unadjusted 12.1% vs. 2.4%, p&lt;0.001, adjusted HR 10.6, 95% CI 7.7-14.8) and non-revascularized patients (unadjusted 10.0% vs. 1.7%, p&lt;0.001, adjusted HR 6.1, 95% CI 4.1-9.2). CONCLUSIONS—In US practice, EF reassessments are commonly performed among MI patients with an initially reduced EF. While 1-year EF reassessment is associated with increased likelihood of ICD implantation, 1-year ICD implantation rates remain very low even among patients with EF reassessment, regardless of revascularization status.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.116.022359</identifier><identifier>PMID: 27881561</identifier><language>eng</language><publisher>United States: by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><subject>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</subject><ispartof>Circulation (New York, N.Y.), 2017-01, Vol.135 (1), p.38-47</ispartof><rights>2016 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><rights>2016 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4229-f658c7d8f34f3b752b50ac0b844bf0d0d954ba920fcefdcf9b4b7574629585d53</citedby><cites>FETCH-LOGICAL-c4229-f658c7d8f34f3b752b50ac0b844bf0d0d954ba920fcefdcf9b4b7574629585d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27915,27916</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27881561$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pokorney, Sean D</creatorcontrib><creatorcontrib>Miller, Amy L</creatorcontrib><creatorcontrib>Chen, Anita Y</creatorcontrib><creatorcontrib>Thomas, Laine</creatorcontrib><creatorcontrib>Fonarow, Gregg C</creatorcontrib><creatorcontrib>de Lemos, James A</creatorcontrib><creatorcontrib>Al-Khatib, Sana M</creatorcontrib><creatorcontrib>Velazquez, Eric J</creatorcontrib><creatorcontrib>Peterson, Eric D</creatorcontrib><creatorcontrib>Wang, Tracy Y</creatorcontrib><title>Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients with Low Ejection Fraction after Myocardial Infarction</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>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 &lt;0.001) and had shorter times to EF reassessment (median 67 vs. 84 days, p&lt;0.001) than non-revascularized patients. Among patients with EF reassessment, only 11% received an ICD within 1 year. Reassessment of EF was associated with higher likelihood of ICD implantation for both revascularized (unadjusted 12.1% vs. 2.4%, p&lt;0.001, adjusted HR 10.6, 95% CI 7.7-14.8) and non-revascularized patients (unadjusted 10.0% vs. 1.7%, p&lt;0.001, adjusted HR 6.1, 95% CI 4.1-9.2). CONCLUSIONS—In US practice, EF reassessments are commonly performed among MI patients with an initially reduced EF. While 1-year EF reassessment is associated with increased likelihood of ICD implantation, 1-year ICD implantation rates remain very low even among patients with EF reassessment, regardless of revascularization status.</description><subject>Aged</subject><subject>Databases, Factual</subject><subject>Defibrillators, Implantable</subject><subject>Female</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medicare</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Revascularization</subject><subject>Proportional Hazards Models</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Stroke Volume</subject><subject>Survival Rate</subject><subject>Tomography, X-Ray Computed</subject><subject>Ultrasonography</subject><subject>United States</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqNkc9u1DAQxi0EotvCKyBz45Liv0l84BCFLo20pajqniPHGbMpTrzYCau-DM_abLMgceM0mvFvvk_jD6H3lFxSmtKPZXVXbjfFfXX7tbgujrNLwhiX6gVaUclEIiRXL9GKEKKSjDN2hs5jfJjblGfyNTpjWZ5TmdIV-n0HOkaIsYdhxN7iUoe20wavp8GMnR-wHlpc9Xunh1E3DhbA_4IwQkg-g-2a0DmnRx_wNgIuej98xzfQdkYHwN_02M3KER-6cYc3_oCvHmARXgd9crCzFL559ObZ2-FqsDo8v71Br6x2Ed6e6gXarq_uy-tkc_ulKotNYgRjKrGpzE3W5pYLy5tMskYSbUiTC9FY0pJWSdFoxYg1YFtjVSNmKhMpUzKXreQX6MOiuw_-5wRxrPsuGpjvGsBPsaa54CpVjLMZVQtqgo8xgK33oet1eKwpqY_x1P_Gc5zVSzzz7ruTzdT00P7d_JPHDHxagIN386fEH246QKh3oN24-w-DJ7e6pAw</recordid><startdate>20170103</startdate><enddate>20170103</enddate><creator>Pokorney, Sean D</creator><creator>Miller, Amy L</creator><creator>Chen, Anita Y</creator><creator>Thomas, Laine</creator><creator>Fonarow, Gregg C</creator><creator>de Lemos, James A</creator><creator>Al-Khatib, Sana M</creator><creator>Velazquez, Eric J</creator><creator>Peterson, Eric D</creator><creator>Wang, Tracy Y</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170103</creationdate><title>Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients with Low Ejection Fraction after Myocardial Infarction</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4229-f658c7d8f34f3b752b50ac0b844bf0d0d954ba920fcefdcf9b4b7574629585d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Databases, Factual</topic><topic>Defibrillators, Implantable</topic><topic>Female</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medicare</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardial Revascularization</topic><topic>Proportional Hazards Models</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Stroke Volume</topic><topic>Survival Rate</topic><topic>Tomography, X-Ray Computed</topic><topic>Ultrasonography</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pokorney, Sean D</creatorcontrib><creatorcontrib>Miller, Amy L</creatorcontrib><creatorcontrib>Chen, Anita Y</creatorcontrib><creatorcontrib>Thomas, Laine</creatorcontrib><creatorcontrib>Fonarow, Gregg C</creatorcontrib><creatorcontrib>de Lemos, James A</creatorcontrib><creatorcontrib>Al-Khatib, Sana M</creatorcontrib><creatorcontrib>Velazquez, Eric J</creatorcontrib><creatorcontrib>Peterson, Eric D</creatorcontrib><creatorcontrib>Wang, Tracy Y</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pokorney, Sean D</au><au>Miller, Amy L</au><au>Chen, Anita Y</au><au>Thomas, Laine</au><au>Fonarow, Gregg C</au><au>de Lemos, James A</au><au>Al-Khatib, Sana M</au><au>Velazquez, Eric J</au><au>Peterson, Eric D</au><au>Wang, Tracy Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients with Low Ejection Fraction after Myocardial Infarction</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2017-01-03</date><risdate>2017</risdate><volume>135</volume><issue>1</issue><spage>38</spage><epage>47</epage><pages>38-47</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>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 &lt;0.001) and had shorter times to EF reassessment (median 67 vs. 84 days, p&lt;0.001) than non-revascularized patients. Among patients with EF reassessment, only 11% received an ICD within 1 year. Reassessment of EF was associated with higher likelihood of ICD implantation for both revascularized (unadjusted 12.1% vs. 2.4%, p&lt;0.001, adjusted HR 10.6, 95% CI 7.7-14.8) and non-revascularized patients (unadjusted 10.0% vs. 1.7%, p&lt;0.001, adjusted HR 6.1, 95% CI 4.1-9.2). CONCLUSIONS—In US practice, EF reassessments are commonly performed among MI patients with an initially reduced EF. While 1-year EF reassessment is associated with increased likelihood of ICD implantation, 1-year ICD implantation rates remain very low even among patients with EF reassessment, regardless of revascularization status.</abstract><cop>United States</cop><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><pmid>27881561</pmid><doi>10.1161/CIRCULATIONAHA.116.022359</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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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
title Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients with Low Ejection Fraction after Myocardial Infarction
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