Publications [#158982] of Lesley H Curtis

Papers Published

1. SM Al-Khatib, MA Greiner, ED Peterson, AF Hernandez, KA Schulman, LH Curtis, Patient and implanting physician factors associated with mortality and complications after implantable cardioverter-defibrillator implantation, 2002-2005., Circulation. Arrhythmia and electrophysiology, vol. 1 no. 4 (October, 2008), pp. 240-9, ISSN 1941-3084 [doi]
   (last updated on 2013/07/01)

   Abstract:
   BACKGROUND: Little is known about factors that influence survival and complications after implantable cardioverter-defibrillator (ICD) implantation in routine clinical practice. We examined patient and implanting physician factors associated with outcomes of ICD therapy in Medicare beneficiaries from 2002 through 2005. RESULTS: We limited this analysis to patients aged >or=65 with Medicare fee-for-service coverage who received an ICD between January 2002 and September 2005. The main outcome measures are time to postprocedural complications within 90 days and 1-year mortality. During the study period, 8581 patients had an ICD implanted by 1959 physicians. The number of procedures increased from 1644 in 2002 to 2374 in the first 3 quarters of 2005. The overall complication rate declined from 18.8% in 2002 to 14.2% in 2005 (P<0.001). Factors independently associated with an increased hazard of complications include chronic lung disease, dementia, renal disease, implantation by a thoracic surgeon, and implantation with removal/replacement. History of congestive heart failure, outpatient implantation, and more recent years of ICD implantation were associated with a lower risk of complications (P<0.05 for all factors). From 2002 to 2005, we observed a decline in 1-year mortality (P<0.001). CONCLUSIONS: We observed an appreciable increase in the number of ICD implants, which was associated with a significant decrease in the rate of complications and 1-year mortality. We identified factors associated with an increased risk of mortality and postprocedural complications that may support more nuanced treatment decisions than are currently possible.

   Keywords:
   Aged • Clinical Competence* • Defibrillators, Implantable* • Female • Follow-Up Studies • Heart Failure • Humans • Incidence • Male • Outcome Assessment (Health Care)* • Physician's Role* • Postoperative Complications • Prosthesis Implantation • Retrospective Studies • Risk Factors • Survival Rate • Time Factors • United States • adverse effects* • epidemiology • epidemiology* • therapy* • trends