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Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Myocardial Infarction.
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.
Afiliação
  • Pokorney SD; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • Miller AL; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • Chen AY; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • Thomas L; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • Fonarow GC; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • de Lemos JA; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • Al-Khatib SM; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • Velazquez EJ; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • Peterson ED; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
  • Wang TY; From Duke University Medical Center, Durham, NC (S.D.P., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Duke Clinical Research Institute, Durham, NC (S.D.P., A.Y.C., L.T., S.M.A.-K., E.J.V., E.D.P., T.Y.W.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (A.L.M.); UCLA Health System, Los A
Circulation ; 135(1): 38-47, 2017 Jan 03.
Article em En | MEDLINE | ID: mdl-27881561
ABSTRACT

BACKGROUND:

Guidelines recommend that patients with low ejection fraction (EF) after 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 postdischarge EF reassessment and ICD implantation among 10 289 Medicare-insured patients ≥65 years of age with an EF≤35% during the index MI admission from January 2007 through September 2010 in ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines). 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% confidence interval [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)] versus 53.7% [95% CI, 52.2-55.2]; P<0.001) and had shorter times to EF reassessment (median, 67 versus 84 days; P<0.001) than nonrevascularized patients. Among patients with EF reassessment, only 11% received an ICD within 1 year. Reassessment of EF was associated with a higher likelihood of ICD implantation for both revascularized (unadjusted, 12.1% versus 2.4%, P<0.001; adjusted hazard ratio, 10.6, 95% CI, 7.7-14.8) and nonrevascularized (unadjusted, 10.0% versus 1.7%, P<0.001; adjusted hazard ratio, 6.1, 95% CI, 4.1-9.2) patients.

CONCLUSIONS:

In US practice, EF reassessments are commonly performed among patients with MI with an initially reduced EF. Although 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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Desfibriladores Implantáveis / Infarto do Miocárdio Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Ano de publicação: 2017 Tipo de documento: Article
Texto completo
Imprimir
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Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Desfibriladores Implantáveis / Infarto do Miocárdio Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Ano de publicação: 2017 Tipo de documento: Article