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Robinson I, Daly-Grafstein D, Khan M, Krahn AD, Hawkins NM, Brubacher JR, Staples JA. Distinguishing Primary Prevention From Secondary Prevention Implantable Cardioverter Defibrillators Using Administrative Health and Cardiac Device Registry Data. CJC Open 2024; 6:876-883. [PMID: 39026626 PMCID: PMC11252512 DOI: 10.1016/j.cjco.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/28/2024] [Indexed: 07/20/2024] Open
Abstract
Background Administrative health data and cardiac device registries can be used to empirically evaluate outcomes and costs after implantable cardioverter defibrillator (ICD) implantation. These datasets often have incomplete information on the indication for implantation (primary vs secondary prevention of sudden cardiac death). Methods We used 16 years of population-based cardiac device registry and administrative health data from British Columbia, Canada, to derive and internally validate statistical models that predict the likely indication for ICD implantation. We used chart review data as the reference standard for ICD indication in the Cardiac Device Registry database (CDR; 2004-2012 [Cardiac Services BC]) and nonmissing indication as the reference standard in the Heart Information System registry database (HEARTis; 2013-2019 [Cardiac Services BC]). We created 3 logistic regression prediction models in each database: one using only registry data, one using only administrative data, and one using both registry and administrative data. We assessed the predictive performance of each model using standard metrics after optimism correction with 200 bootstrap resamples. Results Models that used registry data alone demonstrated excellent predictive performance (sensitivity ≥ 89%; specificity ≥ 87%). Models that used only administrative data performed well (sensitivity ≥ 84%; specificity ≥ 70%). Models that used both registry and administrative data showed modest gains over those that used registry data alone (sensitivity ≥ 90%; specificity ≥ 89%). Conclusions Administrative health data and cardiac device registry data can distinguish secondary prevention ICDs from primary prevention ICDs with acceptable sensitivity and specificity. Imputation of missing ICD indication might make these data resources more useful for research and health system monitoring.
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Affiliation(s)
- Isaac Robinson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Daly-Grafstein
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D. Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel M. Hawkins
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R. Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A. Staples
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada
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Banks H, Torbica A, Valzania C, Varabyova Y, Prevolnik Rupel V, Taylor RS, Hunger T, Walker S, Boriani G, Fattore G. Five year trends (2008-2012) in cardiac implantable electrical device utilization in five European nations: a case study in cross-country comparisons using administrative databases. Europace 2019; 20:643-653. [PMID: 29016747 DOI: 10.1093/europace/eux123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/12/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Common methodologies for analysis of analogous data sets are needed for international comparisons of treatment and outcomes. This study tests using administrative hospital discharge (HD) databases in five European countries to investigate variation/trends in pacemaker (PM) and implantable cardioverter defibrillator (ICD) implant rates in terms of patient characteristics/management, device subtype, and initial implantation vs. replacement, and compares findings with existing literature and European Heart Rhythm Association (EHRA) reports. Methods and results HD databases from 2008 to 2012 in Austria, England, Germany, Italy and Slovenia were interrogated to extract admissions (without patient identification) associated with PM and ICD implants and replacements, using direct cross-referencing of procedure codes and common methodology to compare aggregate data. 1 338 199 records revealed 212 952 PM and 62 567 ICD procedures/year on average for a 204.4 million combined population, a crude implant rate of about 104/100 000 inhabitants for PMs and 30.6 for ICDs. The first implant/replacement rate ratios were 81/24 (PMs) and 25/7 (ICDs). Rates have increased, with cardiac resynchronization therapy (CRT) subtypes for both devices rising dramatically. Significant between- and within-country variation persists in lengths of stay and rates (Germany highest, Slovenia lowest). Adjusting for age lessened differences for PM rates, scarcely affected ICDs. Male/female ratios remained stable at 56/44% (PMs) and 79/21% (ICDs). About 90% of patients were discharged to home; 85-100% were inpatient admissions. Conclusion To aid in policymaking and track outcomes, HD administrative data provides a reliable, relatively cheap, methodology for tracking implant rates for PMs and ICDs across countries, as comparisons to EHRA data and the literature indicated.
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Affiliation(s)
- Helen Banks
- Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy
| | - Cinzia Valzania
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Albertoni, 15, 40138 Bologna, Italy
| | - Yauheniya Varabyova
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | | | - Rod S Taylor
- Evidence Synthesis & Modelling for Health Improvement, Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1?2LU, Exeter, UK
| | - Theresa Hunger
- Department of Public Health, Health Services Research and Health Technology Assessment, The University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, 6060 Hall in Tyrol, Austria
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK YO1?6EN, UK
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Via Del Pozzo 71, 41124 Modena, Italy
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy.,Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Torbica A, Banks H, Valzania C, Boriani G, Fattore G. Investigating Regional Variation of Cardiac Implantable Electrical Device Implant Rates in European Healthcare Systems: What Drives Differences? HEALTH ECONOMICS 2017; 26 Suppl 1:30-45. [PMID: 28139088 DOI: 10.1002/hec.3470] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/27/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
Despite established efficacy for cardiac implantable electrical devices (CIEDs), large differences in CIED implant rates have been documented across and within countries. The aim of this paper is to investigate the influence of socio-economic, epidemiological and supply side factors on CIED implant rates across 57 Regions in 5 EU countries and to assess the feasibility of using administrative data for this purpose. A total of 1 330 098 hospitalizations for CIED procedures extracted from hospital discharge databases in Austria, England, Germany, Italy and Slovenia from 2008 to 2012 was used in the analysis. Higher levels of tertiary education among the labour force and percent of aged population are positively associated with implant rates of CIED. Regional per capita GDP and number of implanting centres appear to have no significant effect. Institutional factors are shown to be important for the diffusion of CIED. Wide variation in CIED implant rates across and within five EU countries is undeniable. However, regional factors play a limited part in explaining these differences with few exceptions. Administrative databases are a valuable source of data for investigating the diffusion of medical technologies, while the choice of appropriate modelling strategy is crucial in identifying the drivers for variation across countries. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Aleksandra Torbica
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Helen Banks
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Cinzia Valzania
- Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Boriani
- Modena University Hospital, Universita degli Studi di Modena e Reggio Emilia Facolta di Medicina e Chirurgia, Modena, Italy
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Boriani G, Berti E, Belotti LMB, Biffi M, De Palma R, Malavasi VL, Bottoni N, Rossi L, De Maria E, Mantovan R, Zardini M, Casali E, Marconi M, Bandini A, Tomasi C, Boggian G, Barbato G, Toselli T, Zennaro M, Sassone B. Cardiac device therapy in patients with left ventricular dysfunction and heart failure: ‘real‐world’ data on long‐term outcomes (mortality, hospitalizations, days alive and out of hospital). Eur J Heart Fail 2016; 18:693-702. [DOI: 10.1002/ejhf.509] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/05/2015] [Accepted: 12/26/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, University of Bologna Azienda Ospedaliera S. Orsola‐Malpighi Bologna Italy
- Division of Cardiology, Modena University Hospital University of Modena and Reggio Emilia Modena Italy
| | - Elena Berti
- Agency for Health and Social Care of Emilia‐Romagna Bologna Italy
| | | | - Mauro Biffi
- Institute of Cardiology, University of Bologna Azienda Ospedaliera S. Orsola‐Malpighi Bologna Italy
| | - Rossana De Palma
- Agency for Health and Social Care of Emilia‐Romagna Bologna Italy
| | - Vincenzo L. Malavasi
- Division of Cardiology, Modena University Hospital University of Modena and Reggio Emilia Modena Italy
| | - Nicola Bottoni
- Division of Cardiology S. Maria Nuova Hospital Reggio Emilia Italy
| | - Luca Rossi
- Division of Cardiology G. da Saliceto Hospital Piacenza Italy
| | | | | | - Marco Zardini
- Division of Cardiology Parma University Hospital Parma Italy
| | - Edoardo Casali
- Division of Cardiology, Modena University Hospital University of Modena and Reggio Emilia Modena Italy
| | - Marco Marconi
- Division of Cardiology, Local Health Unit Rimini Italy
| | - Alberto Bandini
- Division of Cardiologia G.B. Morgagni‐L. Pierantoni Hospital Forlì Italy
| | - Corrado Tomasi
- Division of Cardiology S. Maria delle Croci Hospital Ravenna Italy
| | - Giulio Boggian
- Division of Cardiology Hospital of Bentivoglio Bologna Italy
| | | | - Tiziano Toselli
- Division of Cardiology Ferrara University Hospital Ferrara Italy
| | - Mauro Zennaro
- Division of Cardiology Baggiovara Hospital Modena Italy
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Sheetz KH, Norton EC, Birkmeyer JD, Dimick JB. Provider Experience and the Comparative Safety of Laparoscopic and Open Colectomy. Health Serv Res 2016; 52:56-73. [PMID: 26990210 DOI: 10.1111/1475-6773.12482] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the comparative safety of laparoscopic and open colectomy across surgeons varying in experience with laparoscopy. DATA SOURCES National Medicare data (2008-2010) for beneficiaries undergoing laparoscopic or open colectomy. STUDY DESIGN Using instrumental variable methods to address selection bias, we evaluated outcomes of laparoscopic and open colectomy. Our instrument was the regional use of laparoscopy in the year prior to a patient's operation. We then evaluated outcomes stratified by surgeons' annual volume of laparoscopic colectomy. PRINCIPAL FINDINGS Laparoscopic colectomy was associated with lower mortality (OR: 0.75, 95 percent CI: 0.70-0.78) and fewer complications than open surgery (OR: 0.82, 95 percent CI: 0.79-0.85). Increasing surgeon volume was associated with better outcomes for both procedures, but the relationship was stronger for laparoscopy. The comparative safety depended on surgeon volume. High-volume surgeons had 40 percent lower mortality (OR: 0.60, 95 percent CI: 0.55-0.65) and 30 percent fewer complications (OR: 0.70, 95 percent CI: 0.67-0.74) with laparoscopy. Conversely, low-volume surgeons had 7 percent higher mortality (OR: 1.07, 95 percent CI: 1.02-1.13) and 18 percent more complications (OR: 1.18, 95 percent CI: 1.12-1.24) with laparoscopy. CONCLUSIONS This population-based study demonstrates that the comparative safety of laparoscopic and open colectomy is influenced by surgeon volume. Laparoscopic colectomy is only safer for patients whose surgeons have sufficient experience.
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Affiliation(s)
- Kyle H Sheetz
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Edward C Norton
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.,Department of Health Management and Policy, Department of Economics, University of Michigan, Ann Arbor, MI.,National Bureau of Economic Research, Cambridge, MA
| | | | - Justin B Dimick
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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