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Higher Volume Linked to Fewer Adverse Events With ICDs

Odds of event with cardioverter-defibrillator 26 percent higher at low-volume hospitals

THURSDAY, Sept. 23 (HealthDay News) -- Patients who receive an implantable cardioverter-defibrillator (ICD) at a high-volume hospital rather than a low-volume hospital are less likely to have an adverse event related to the procedure, according to research published in the Sept. 28 issue of the Journal of the American College of Cardiology.

James V. Freeman, M.D., of the Stanford University School of Medicine in California, and colleagues analyzed data from the National Cardiovascular Data Registry's ICD Registry on 224,233 patients who underwent implantation in 1,201 hospitals.

The researchers found that increasing procedure volume was associated with a declining rate of adverse events; the odds ratio of any adverse event after implantation was 1.26 for the lowest-volume quartile compared to the highest-volume quartile. The relationship between volume and outcomes was seen for all subtypes of ICDs, including single- and dual-chamber ICDs and biventricular ICDs.

"Our findings demonstrate that patients who have an ICD implanted at a high-volume hospital are less likely to have an adverse event associated with the procedure than a patient who has an ICD implanted at a low-volume center. This volume-outcome relationship was statistically significant, clinically important, and consistent across all subtypes of ICDs, suggesting that implantation of these devices might be preferentially performed at high-volume centers," the authors conclude.

Two co-authors disclosed financial relationships with Medtronic, Boston Scientific, and the National Cardiovascular Data Registry.

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