1
|
Drozda Jr JP, Ssemaganda H, Frankenberger EA, Brandt E, Robbins S, Khairnar N, Cha A, Resnic FS. Testing a Cloud-Based Model for Active Surveillance of Medical Devices with Analyses of Coronary Stent Safety Using the Data Extraction and Longitudinal Trend Analysis (DELTA) System. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:97-105. [PMID: 38434149 PMCID: PMC10908332 DOI: 10.2147/mder.s445160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024] Open
Abstract
Objective To demonstrate the use of the Data Extraction and Longitudinal Trend Analysis (DELTA) system in the National Evaluation System for health Technology's (NEST) medical device surveillance cloud environment by analyzing coronary stent safety using real world clinical data and comparing results to clinical trial findings. Design and Setting Electronic health record (EHR) data from two health systems, the Social Security Death Master File, and device databases were ingested into the NEST cloud, and safety analyses of two stents were performed using DELTA. Participants and Interventions This is an observational study of patients receiving zotarolimus drug-eluting coronary stents (ZES) or everolimus eluting coronary stents (EES) between July 1, 2015 and December 31, 2017. Results After exclusions, 3334 patients receiving EES and 1002 receiving ZES were available for study. Analysis using inverse probability weighting showed no significant difference in one-year mortality or major adverse cardiac events (MACE) for EES compared to ZES [Mortality Odds Ratio 0.94 (95% CI 0.81-1.175); p = 0.780] [MACE Odds Ratio 1.04 (95% CI 0.92-1.16; p = 0.551]). Analysis using propensity matching showed no significant difference in EES one-year mortality (547 of 992 alive and available after censoring) compared to ZES (546 of 992) [Log-Rank statistic 0.3348 (p = 0.563)]. Conclusion Automated cloud-based medical device safety surveillance using EHR data is feasible and was efficiently performed using DELTA. No statistically significant differences in 1-year safety outcomes between ZES and EES were identified using two statistical approaches, consistent with randomized trial findings.
Collapse
Affiliation(s)
| | - Henry Ssemaganda
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | | | - Susan Robbins
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Neha Khairnar
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | - Frederic S Resnic
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| |
Collapse
|
2
|
Caughron H, Bowman H, Raitt MH, Whooley MA, Tarasovsky G, Shen H, Matheny ME, Selzman KA, Wang L, Major J, Odobasic H, Dhruva SS. Cardiovascular implantable electronic device lead safety: Harnessing real-world remote monitoring data for medical device evaluation. Heart Rhythm 2023; 20:512-519. [PMID: 36586706 DOI: 10.1016/j.hrthm.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current methods to identify cardiovascular implantable electronic device lead failure include postapproval studies, which may be limited in scope, participant numbers, and attrition; studies relying on administrative codes, which lack specificity; and voluntary adverse event reporting, which cannot determine incidence or attribution to the lead. OBJECTIVE The purpose of this study was to determine whether adjudicated remote monitoring (RM) data can address these limitations and augment lead safety evaluation. METHODS Among 48,191 actively monitored patients with a cardiovascular implantable electronic device, we identified RM transmissions signifying incident lead abnormalities and, separately, identified all leads abandoned or extracted between April 1, 2019, and April 1, 2021. We queried electronic health record and Medicare fee-for-service claims data to determine whether patients had administrative codes for lead failure. We verified lead failure through manual electronic health record review. RESULTS Of the 48,191 patients, 1170 (2.4%) had incident lead abnormalities detected by RM. Of these, 409 patients had administrative codes for lead failure, and 233 of these 409 patients (57.0%) had structural lead failure verified through chart review. Of the 761 patients without administrative codes, 167 (21.9%) had structural lead failure verified through chart review. Thus, 400 patients with RM transmissions suggestive of lead abnormalities (34.2%) had structural lead failure. In addition, 200 patients without preceding abnormal RM transmissions had leads abandoned or extracted for structural failure, making the total lead failure cohort 600 patients (66.7% with RM abnormalities, 33.3% without). Patients with isolated right atrial or left ventricular lead failure were less likely to have lead replacement and administrative codes reflective of lead failure. CONCLUSION RM may strengthen real-world assessment of lead failure, particularly for leads where patients do not undergo replacement.
Collapse
Affiliation(s)
- Hope Caughron
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Hilary Bowman
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Merritt H Raitt
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon; Portland Veterans Affairs Health Care System, Portland, Oregon
| | - Mary A Whooley
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Gary Tarasovsky
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Hui Shen
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michael E Matheny
- Geriatrics Research, Education, and Clinical Service, Tennessee Valley Veterans Affairs Health Care System, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kimberly A Selzman
- Division of Cardiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Salt Lake City Veterans Affairs Health Care System, Salt Lake City, Utah
| | - Li Wang
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Jacqueline Major
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Hetal Odobasic
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sanket S Dhruva
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.
| |
Collapse
|
3
|
Giacopelli D, Azzolina D, Comoretto RI, Quartieri F, Rovaris G, Schillaci V, Gargaro A, Gregori D. Implantable cardioverter defibrillator lead performance: A systematic review and individual patient data Meta-analysis. Int J Cardiol 2023; 373:57-63. [PMID: 36460209 DOI: 10.1016/j.ijcard.2022.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reliable post-approval surveillance of implantable cardioverter-defibrillator (ICD) lead performance remains a challenge. In the past, two ICD leads were recalled due to a high frequency of failures. In this meta-analysis, we sought to provide a combined estimate of failure-free rate for ICD leads by reconstructing individual patient data from published Kaplan-Meier (KM) curves and to investigate whether estimates could be influenced by the characteristics of the study. METHODS Observational studies assessing failure-free estimates of transvenous ICD leads with KM method, were identified through a systematic search up to November 2021. RESULTS Forty-four studies were eligible that included 41,870 (63.1%) non-recalled leads and 24,493 (36.9%) recalled leads. The 8-year cumulative failure-free rate was 94.1% (CI, 93.6% - 94.6%) for contemporary non-recalled leads and 81.2% (80.3% - 82.0%) for recalled leads (hazard ratio [HR], 3.15 [2.85-3.47], p < 0.001). Failure-free rate was lower in single-center studies in both the non-recalled (HR, 0.28 [0.15-0.51], p < 0.001) and recalled (HR, 0.54 [0.33-0.88], p = 0.014) group compared with multicenter studies. Similarly, estimates were significantly lower in small (i.e. extracted KM curve with <312 leads) versus large studies (HR non-recalled group, 0.54 [CI, 0.33-0.89], p = 0.015; HR recalled group, 0.62 [CI, 0.43-0.89], p = 0.009). CONCLUSIONS In this meta-analysis including >66,000 leads, we provide pooled survival curves that may play a role in generating evidence-based standards for assessing clinically acceptable failure rates for ICD leads. Lead performance was underestimated with single-center and small-sized studies; multicenter studies remain the main tool to reliably conduct post-market surveillance of ICD leads.
Collapse
Affiliation(s)
- Daniele Giacopelli
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy; Clinical Unit, Biotronik Italia, Milan, Italy.
| | - Danila Azzolina
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | | | - Fabio Quartieri
- Department of Cardiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | | | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy
| |
Collapse
|
4
|
Anderson C, Olshansky B. The LEADR ICD lead study: Is thinner better? J Cardiovasc Electrophysiol 2023; 34:268-269. [PMID: 36378785 DOI: 10.1111/jce.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Christian Anderson
- Cardiology, The University of Iowa Hospitals and Clinics, Iowa, Iowa City, USA
| | - Brian Olshansky
- Cardiology, The University of Iowa Hospitals and Clinics, Iowa, Iowa City, USA
| |
Collapse
|
5
|
Yang Y, Birgersdotter-Green U. The subcutaneous implantable cardioverter-defibrillator should be reserved for niche indications. Heart Rhythm O2 2022; 3:597-601. [PMID: 36340490 PMCID: PMC9626898 DOI: 10.1016/j.hroo.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Ulrika Birgersdotter-Green
- Address reprint requests and correspondence: Dr Ulrika Birgersdotter-Green, 9452 Medical Center Dr, MC 7411, La Jolla, CA 92037.
| |
Collapse
|
6
|
Dhruva SS, Zhang S, Chen J, Noseworthy PA, Doshi AA, Agboola KM, Herrin J, Jiang G, Yu Y, Cafri G, Collison Farr K, Ervin KR, Ross JS, Coplan PM, Drozda JP. Safety and Effectiveness of a Catheter With Contact Force and 6-Hole Irrigation for Ablation of Persistent Atrial Fibrillation in Routine Clinical Practice. JAMA Netw Open 2022; 5:e2227134. [PMID: 35976649 PMCID: PMC9386540 DOI: 10.1001/jamanetworkopen.2022.27134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The ThermoCool SmartTouch catheter (ablation catheter with contact force and 6-hole irrigation [CF-I6]) is approved by the US Food and Drug Administration (FDA) for paroxysmal atrial fibrillation (AF) ablation and used in routine clinical practice for persistent AF ablation, although clinical outcomes for this indication are unknown. There is a need to understand whether data from routine clinical practice can be used to conduct regulatory-grade evaluations and support label expansions. OBJECTIVE To use health system data to compare the safety and effectiveness of the CF-I6 catheter for persistent AF ablation with the ThermoCool SmartTouch SurroundFlow catheter (ablation catheter with contact force and 56-hole irrigation [CF-I56]), which is approved by the FDA for this indication. DESIGN, SETTING, AND PARTICIPANTS This retrospective, comparative-effectiveness cohort study included patients undergoing catheter ablation for persistent AF at Mercy Health or Mayo Clinic from January 1, 2014, to April 30, 2021, with up to a 1-year follow-up using electronic health record data. EXPOSURES Use of the CF-I6 or CF-I56 catheter. MAIN OUTCOMES AND MEASURES The primary safety outcome was a composite of death, thromboembolic events, and procedural complications within 7 to 90 days. The exploratory effectiveness outcome was a composite of AF-related hospitalization events after a 90-day blanking period. Propensity score weighting was used to balance baseline covariates. Risk differences were estimated between catheter groups and averaged across the 2 health care systems, testing for noninferiority of the CF-I6 vs the CF-I56 catheter with respect to the safety outcome using 2-sided 90% CIs. RESULTS Overall, 1450 patients (1034 [71.3%] male; 1397 [96.3%] White) underwent catheter ablation for persistent AF, including 949 at Mercy Health (186 CF-I6 and 763 CF-I56; mean [SD] age, 64.9 [9.2] years) and 501 at Mayo Clinic (337 CF-I6 and 164 CF-I56; mean [SD] age, 63.7 [9.5] years). A total of 798 (55.0%) had been treated with class I or III antiarrhythmic drugs before ablation. The safety outcome (CF-I6 - CF-I56) was similar at both Mercy Health (1.3%; 90% CI, -2.1% to 4.6%) and Mayo Clinic (-3.8%; 90% CI, -11.4% to 3.7%); the mean difference was noninferior, with a mean of 0.5% (90% CI, -2.6% to 3.5%; P < .001). The effectiveness was similar at 12 months between the 2 catheter groups (mean risk difference, -1.8%; 90% CI, -7.3% to 3.7%). CONCLUSIONS AND RELEVANCE In this cohort study, the CF-I6 catheter met the prespecified noninferiority safety criterion for persistent AF ablation compared with the CF-I56 catheter, and effectiveness was similar. This study demonstrates the ability of electronic health care system data to enable safety and effectiveness evaluations of medical devices.
Collapse
Affiliation(s)
- Sanket S. Dhruva
- Section of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Shumin Zhang
- MedTech Epidemiology and Real-World Data Sciences, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, New Jersey
| | - Jiajing Chen
- Mercy Research, Mercy Health, Chesterfield, Missouri
| | | | | | - Kolade M. Agboola
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Guoqian Jiang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Yue Yu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Guy Cafri
- MedTech Epidemiology and Real-World Data Sciences, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, New Jersey
| | | | - Keondae R. Ervin
- National Evaluation System for Health Technology Coordinating Center, Medical Device Innovation Consortium, Arlington, Virginia
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
| | - Paul M. Coplan
- MedTech Epidemiology and Real-World Data Sciences, Office of the Chief Medical Officer, Johnson & Johnson, New Brunswick, New Jersey
| | | |
Collapse
|
7
|
Kramer DB, Cohen DJ, Parasidis E. Comparative Effectiveness Research and Cardiovascular Device Registries: Aligning Policy and Methods. Circ Cardiovasc Qual Outcomes 2021; 14:e007911. [PMID: 34311564 DOI: 10.1161/circoutcomes.121.007911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.B.K.)
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY and St. Francis Hospital, Roslyn, NY (D.J.C.)
| | - Efthimios Parasidis
- Moritz College of Law and College of Public Health, The Ohio State University, Columbus (E.P.)
| |
Collapse
|
8
|
Affiliation(s)
- Emily P. Zeitler
- Dartmouth-Hitchcock Medical Center and The Dartmouth Institute, Lebanon, NH (E.P.Z.)
- Geisel School of Medicine at Dartmouth, Hanover, NH (E.P.Z.)
| | - Kimberly A. Selzman
- George E. Wahlen Department of Veterans Affairs Medical Center and University of Utah School of Medicine, Salt Lake City, UT (K.A.S.)
| |
Collapse
|