Cardiovascular Business - October/November 2007 - (Page 24) iNside the iCd NatiONal registrY Chair of the ICD National Registry steering committee and former president of the Heart Rhythm Society, Stephen C. Hammill, MD, FHRS, clinical professor of medicine and ECG laboratory director at Mayo Clinic, in Rochester, Minn., details Year One. Q A CVB: What is most noteworthy about the information gathered in the ICD registry during the first year? Dr. Hammill: The most important aspect of the registry is that it’s collecting information on outcomes at the time of ICD implantation and then that information is returned to the hospitals quarterly. An individual hospital is compared to the national average and to hospitals of their own size to see how they’re performing. They can see if their rates for various complications are within the range that we’re seeing with other hospitals. This is also a global overview of the type of data that are being collected by the registry which gives us a research and publication process where people can look at the data specifically and develop research proposals and publications. We have four of those research studies being presented at the American Heart Association meeting in Orlando in November. who received ICDs were male, and it’s a question of whether the device is being underutilized in women or if that’s an appropriate number. The only way we’ll be able to answer that question is to get an idea of how many women in general meet criteria for ICDs. There is an American Heart Association registry and the Medicare claims data. We’ll have to compare this registry data with those registries to get an idea if the device is being used appropriately in women; the same holds true for the race distribution. [Eighty-three percent of the patients were white.] Q A CVB: How important is it to collect ICD data? Q A CVB:Were there any surprises in the annual report? o Dr. Hammill: One thing that was a surprise—the complication rate is low; that’s a pleasing surprise. And the in-hospital death at the time of ICD implantation was 0.02 percent. In previous publications, the complication rate was about 0.5 percent—much higher than we’re seeing now. So that’s a pleasing find and to me suggests that over the years people have become more experienced with the procedure. The other pleasing find was that 85 percent of the physicians who are implanting ICDs have gone through some type of formal training to gain experience. Now we would like the other 15 percent to go through similar training. But a lot of that is dependent upon hospital credentialing committees and how strict they are when they are approving someone to implant ICDs. And the third thing that just needs to be looked at further and compared with other data and registries is the issue of race and gender. Nearly 75 percent of the people Dr. Hammill: I think there are two places where it’s important. One is hospitals now are all working on ways of improving their own quality and outcomes. The registry gives them benchmarking data to compare their ICD program with other hospitals. Secondly, insurance companies are looking at the registry in terms of pay-for-performance or their quality programs and starting to look at these registries as something that needs to be done by their providers to insure quality. For example, United Healthcare has made it mandatory for participants in their program to participate in the registry. If a hospital wants to be labeled as a United Health Premium Cardiac Specialty Center, they have to be entering patients into the registry. Basically, United is doing that as a means to track performance. Q A CVB: Are there any weaknesses within the IDC reporting system? Dr. Hammill: The weakness is getting good quality follow-up data. We have the data on ICD implantation, but we don’t have follow-up data. That’s something we need and we plan to do that in two ways. One: we will enhance some of the follow-up aspects of the registry data 24 Cardiovascular Business October/November 2007
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