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Regional variations in physicians' attitudes and recommendations surrounding implantable cardioverter-defibrillators.

Abstract：

INTRODUCTION:This study was designed to determine if physicians' attitudes and recommendations surrounding implantable cardioverter-defibrillators (ICDs) are regionally associated with ICD use. METHODS AND RESULTS:A national sample of 9969 members of the American College of Cardiology was surveyed electronically. Responses were merged with rates of ICD implantation from the National Cardiovascular Data Registry. Multivariable regression was used to assess trends between regional use and responses. We received 1210 responses (12%) and used 1124 after exclusions. Across regions, physicians were equally likely to recommend ICDs to males or females with ischemic (∼99% for both; P = NS) or nonischemic cardiomyopathy (85 vs. 88% P = 0.85). Significant increasing trends in the probability recommending ICD therapy were found when the patient was "frail" (21% to 32%; P = .03) or had a life expectancy <1 year (5% to 10%; P = .05). These differences were not associated with attitudes toward ICDs. CONCLUSIONS:Independent of variations in physicians' attitudes towards ICDs, physicians in regions of low ICD use are not less likely to recommend ICDs in situations clearly supported by guidelines while those in regions of high ICD use are more likely to recommend ICDs to patients who might have limited benefit.

journal_name

J Card Fail

journal_title

Journal of cardiac failure

authors

Matlock DD,Kutner JS,Emsermann CB,Al-Khatib SM,Sanders GD,Dickinson LM,Rumsfeld JS,Davidson AJ,Crane LA,Masoudi FA

doi

10.1016/j.cardfail.2010.11.009

subject

Has Abstract

pub_date

2011-04-01 00:00:00

pages

318-24

issue

4

eissn

1071-9164

issn

1532-8414

pii

S1071-9164(10)01229-7

journal_volume

17

pub_type

杂志文章

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