Trends in Use and In-Hospital Outcomes of Subcutaneous Implantable Cardioverter Defibrillators in Patients Undergoing Long-Term Dialysis.
| Title: | Trends in Use and In-Hospital Outcomes of Subcutaneous Implantable Cardioverter Defibrillators in Patients Undergoing Long-Term Dialysis. |
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| Authors: | Pun PH; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.; Division of Nephrology, Duke University Medical Center, Durham, North Carolina.; Parzynski CS; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.; Friedman DJ; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Sanders G; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.; Curtis JP; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Al-Khatib SM; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.; Division of Cardiology, Duke University Medical Center, Durham, North Carolina. |
| Source: | Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2020 Nov 06; Vol. 15 (11), pp. 1622-1630. Date of Electronic Publication: 2020 Sep 23. |
| Publication Type: | Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101271570 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1555-905X (Electronic) Linking ISSN: 15559041 NLM ISO Abbreviation: Clin J Am Soc Nephrol Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2023- : Hagerstown, MD : Wolters Kluwer Health; Original Publication: Washington, D.C. : American Society of Nephrology, c2005- |
| MeSH Terms: | Defibrillators, Implantable/*statistics & numerical data ; Prosthesis Implantation/*methods ; Prosthesis Implantation/*trends ; Renal Dialysis/*statistics & numerical data; Defibrillators, Implantable/adverse effects ; Heart Arrest/epidemiology ; Length of Stay/statistics & numerical data ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prosthesis Implantation/adverse effects ; Renal Dialysis/adverse effects ; United States/epidemiology ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Time Factors |
| Abstract: | Background and Objectives: Patients on dialysis are at high risk of complications related to implantable cardioverter defibrillator (ICD) implantation; use of subcutaneous ICDs may be preferred over transvenous devices due to lower risk of bloodstream infection and interference with vascular access sites. We evaluated trends in use and in-hospital outcomes of subcutaneous compared with transvenous ICDs among patients on dialysis in the United States.; Design, Setting, Participants, & Measurements: Retrospective analysis of ICD implants from 2012 to 2018 among patients on dialysis reported to the National Cardiovascular Data Registry ICD Registry, a nationally representative US ICD Registry. We examined overall trends in subcutaneous ICD adoption as a proportion of all eligible ICD implants among patients on dialysis and then compared in-hospital outcomes between eligible subcutaneous ICD and transvenous ICD recipients using inverse probability of treatment weighting.; Results: Of the 23,136 total ICD implants in patients on dialysis during the study period, 3195 (14%) were subcutaneous ICDs. Among eligible first-time ICD recipients on dialysis, the proportion of subcutaneous ICDs used increased yearly from 10% in 2012 to 69% in 2018. In propensity score-weighted analysis of 3327 patients, compared with transvenous ICDs, patients on dialysis receiving subcutaneous ICDs had a higher rate of in-hospital cardiac arrest (2% versus 0.4%, P=0.002), but there was no significant difference in total in-hospital complications (2% versus 1%, P=0.08), all-cause death, or length of hospital stay.; Conclusions: The utilization of subcutaneous ICDs among US patients on dialysis has been steadily increasing. The overall risk of short-term complications is low and comparable with transvenous ICDs, but higher risks of in-hospital cardiac arrest merits closer monitoring and further investigation.; Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_09_23_CJN07920520.mp3.; (Copyright © 2020 by the American Society of Nephrology.) |
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| Grant Information: | R03 DK113324 United States DK NIDDK NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS |
| Contributed Indexing: | Keywords: arteriovenous access; cardiovascular; cardiovascular disease; defibrillators; dialysis; dialysis access; end stage kidney disease; epidemiology and outcomes; hospitals; implantable |
| Entry Date(s): | Date Created: 20200924 Date Completed: 20211122 Latest Revision: 20230421 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC7646229 |
| DOI: | 10.2215/CJN.07920520 |
| PMID: | 32967922 |
| Database: | MEDLINE |
Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't