In response to the study, Non-Evidence-Based Implantable Cardioverter-Defibrillator (ICD) Implantations in the United States , published in the January 5 issue of the Journal of the American Medical Association (JAMA), the American College of Cardiology (ACC) and Heart Rhythm Society (HRS) reiterate the importance of research and measurement tools designed to improve patient care. The message and teachings of this important study indicate that substantial variations exist among hospital ICD implantation strategies. This variation clearly demonstrates an opportunity for improvement in care delivery. The findings are critical for the cardiovascular community and our patients in moving forward our commitment to change practice patterns to deliver higher quality, evidence-based, cost-effective care.
The NCDR ICD Registry™ was created in partnership by the ACC and HRS in response to a mandate by the Centers for Medicare and Medicaid Services (CMS). Every U.S. hospital that implants ICDs for the purpose of primary prevention of sudden cardiac death participates in the NCDR ICD Registry™. The Registry has developed the ability to connect longitudinal Medicare administrative data of patient outcomes such as mortality and repeat hospitalizations with our in-patient hospital registry data.
The evaluation of what clinicians are doing through the collection of the Registry data can help us to learn about practice patterns and gain a better understanding of how clinical practice guidelines are implemented but also potentially extend our knowledge and evidence base.
ACC and HRS acknowledge that there are instances that inappropriate use of ICD implantation is occurring and that it is our responsibility as professional societies to provide measurement tools, such as the NCDR, that can help address inappropriate use. With that caveat, the vast majority of implanting physicians are prescribing ICDs with the confidence that they are providing the best care for their patients. The study authors emphasize that “the ultimate judgment of the care of a particular patient must be made by the physician and the patient in light of all of the circumstances presented by the patient. There are circumstances in which deviations from these guidelines are appropriate.” While guidelines are designed to account for the majority of clinical scenarios, there are clinical challenges in which the guidelines do not address the unique circumstances of a patient’s treatment options which require physicians to utilize their clinical expertise and judgment.
We are dedicated to improving the care of patients by promoting research, education and optimal health care policies and standards. We believe ICDs to be effective in stopping life-threatening arrhythmias and encourage research that will further improve the use and effectiveness of this therapy to enhance survival and overall quality of care.
The NCDR ICD Registry™ has reaped substantial benefits in understanding and improving clinical practice related to ICD implantation with much more on the horizon. The ACC and HRS strongly support additional measures that would advance the safety of patients living with ICDs.