In 2012, the first totally Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) was approved by the Food and Drug Administration (FDA) in the United States. A possible benefit of this device is that it does not involve placing leads 'in' or 'on' the heart, potentially reducing complications. Ninety-one S-ICD and 182 single chamber TV-ICD implants were performed between 10/22/2012 and 9/22/2015. During this period of time, 91 patients with S-ICD were matched to TV-ICD patients using single centre NCDR ICD Registry Data based on dialysis status, gender, and age. Intra- and post-operative complications and deaths were examined within the first 180 days following implantation. Patients with S-ICDs had higher creatinine (2.3 ± 2.5 vs. 1.1 ± 0.7, P < 0.001) and were more likely to be on chronic dialysis (20.9% vs. 5.5%, P < 0.001) than TV-ICD patients. Patients in the S-ICD group were more likely to have had prior device infections (14.3% vs. 3.3%, P = 0.021) as well as prior TIA/CVA (14.3% vs. 4.4%, P = 0.049) compared to patients in the TV-ICD group. Seven patients experienced 7 complications or death in TV-ICD group and 5 patients experienced 7 complications or death in SQ-ICD group, P = 0.774. In this retrospective matched single centre cohort study, there was no significant difference in implantation complications or death in patients receiving single chamber TV-ICDs compared to S-ICDs within 6 months following implantation. This occurred despite more severe preexisting illness in the S-ICD group. Further investigation is needed to determine outcomes after longer-term follow-up.
Background: Millions of Americans are living with heart failure (HF), and minorities represent a large proportion of these patients. Racial differences in outcomes of patients with HF have been previously described. Examining racial differences in presentation and factors precipitating admission with HF in minorities may help to reduce gaps in care and improve outcomes. Methods: We examined 3763 all-cause admissions for HF at our center (2005-2012) using the GWTG-HF study. Minorities represented 33% of the overall cohort (1216 blacks and 39 other races). Baseline characteristics and outcomes were compared between minorities and Caucasians using independent T Test, Pearson Chi Square and Fisher Exact Test during index admissions. Results: Racial differences in baseline characteristics and comorbidities were identified. (Table) Compared to Caucasians, minorities were younger, had a higher BMI, and were more likely to have nonischemic cardiomyopathy, HTN, diabetes, and renal insufficiency. Minorities were also more likely to be uninsured and were less likely to have CAD, prior MI and atrial fibrillation. Minorities had a 1.3 times greater odds than Caucasians to be readmitted (95% CI 1.1 -1.5). When examining factors contributing to HF admission, minorities were more likely to have medical (34% vs. 17%) or dietary (63% vs. 51%) noncompliance, worsening renal failure (28% vs. 21%), or worsening hypertension (46% vs. 28%) than Caucasians. (p <0.001 for all). Conclusion: Minorities with HF demonstrated significant differences in comorbidities, insurance status, and triggers for HF exacerbations than Caucasians, leading to a greater risk for re-hospitalization. A focus on racial differences in factors precipitating HF exacerbations or potential differences related to access to care that vary by race may provide a more targeted approach to improving outcomes and reducing readmissions, helping to reduce racial gaps.
Trends and in-hospital outcomes associated with early adoption of the subcutaneous implantable cardioverter defibrillator (S-ICD) in the United States have not been described.
Objectives
To describe early use of the S-ICD in the United States and to compare in-hospital outcomes among patients undergoing S-ICD vs transvenous (TV)-ICD implantation.
Design, Setting, and Participants
A retrospective analysis of 393 734 ICD implants reported to the National Cardiovascular Data Registry ICD Registry, a nationally representative US ICD registry, between September 28, 2012 (US Food and Drug Administration S-ICD approval date), and March 31, 2015, was conducted. A 1:1:1 propensity-matched analysis of 5760 patients was performed to compare in-hospital outcomes among patients with S-ICD with those of patients with single-chamber (SC)–ICD and dual-chamber (DC)–ICD.
Main Outcomes and Measures
Analysis of trends in S-ICD adoption as a function of total ICD implants and comparison of in-hospital outcomes (death, complications, and defibrillation threshold [DFT] testing) among S-ICD and TV-ICD recipients.
Results
Of the 393 734 ICD implants evaluated during the study period, 3717 were S-ICDs (0.9%). A total of 109 445 (27.8%) of the patients were female; the mean (SD) age was 67.03 (13.10) years. Use of ICDs increased from 0.2% during the fourth quarter of 2012 to 1.9% during the first quarter of 2015. Compared with SC-ICD and DC-ICD recipients, those with S-ICDs were more often younger, female, black, undergoing dialysis, and had experienced prior cardiac arrest. Among 2791 patients with S-ICD who underwent DFT testing, 2588 (92.7%), 2629 (94.2%), 2635 (94.4%), and 2784 (99.7%) were successfully defibrillated (≤65, ≤70, ≤75, and ≤80 J, respectively). In the propensity-matched analysis of 5760 patients, in-hospital complication rates associated with S-ICDs (0.9%) were comparable to those of SC-ICDs (0.6%) (P = .27) and DC-ICD rates (1.5%) (P = .11). Mean (SD) length of stay after S-ICD implantation was comparable to that after SC-ICD implantation (1.1 [1.5] vs 1.0 [1.2] days;P = .77) and less than after DC-ICD implantation (1.1 [1.5] vs 1.2 [1.5] days;P < .001).
Conclusions and Relevance
The use of S-ICDs is rapidly increasing in the United States. Early adoption has been associated with low complication rates and high rates of successful DFT testing despite frequent use in patients with a high number of comorbidities.
