Association between socioeconomic factors and ICD implantation in a publicly financed health care system: A Danish nationwide study

Matilde Winther-Jensen; Christian Hassager; Jens Flensted Lassen; Lars Køber; Christian Torp-Pedersen; Steen Møller Hansen; Freddy Lippert; Erika Frischknecht Christensen; Kristian Kragholm; Jesper Kjaergaard

doi:10.1093/europace/eux223

Association between socioeconomic factors and ICD implantation in a publicly financed health care system: A Danish nationwide study

Matilde Winther-Jensen^*
, Christian Hassager
, Jens Flensted Lassen
, Lars Køber
, Christian Torp-Pedersen
, Steen Møller Hansen
, Freddy Lippert
, Erika Frischknecht Christensen
, Kristian Kragholm
, Jesper Kjaergaard

^*Kontaktforfatter

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

Aims For patients surviving out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, implantable cardioverter defibrillator (ICD) is recommended for non-reversible causes of arrest. We aimed to determine factors associated with implantation of ICD and survival in patients surviving non-AMI OHCA in a nationwide register covering all OHCAs in Denmark. Methods and results We identified 36 950 OHCAs between 2001 and 2012, 1700 of whom were ICD nai?ve, >18 years, of non-AMI cardiac aetiology and surviving until discharge. Six hundred fifty eight patients had ICD implanted during index admission. Association to ICD implantation during index admission was analysed in logistic regression, survival was assessed using Cox regression. Implantable cardioverter defibrillator implantation increased during the study period [odds ratio (OR) 1-year increase: 1.04, 95% confidence intervals (95% CI): 1.00?1.08, P = 0.03]. Non-shockable rhythm and age >70 years were associated with lower odds of ICD implantation (ORnon-shockable: 0.27, 95% CI: 0.19?0.37, P < 0.001, OR70?79 years: 0.71, 95% CI: 0.52?0.98, P = 0.04, OR>80 years: 0.13, 95% CI: 0.07?0.22, P < 0.001). Non-AMI ischaemic heart disease, highest income tertile and chronic heart failure were associated with higher odds (ORIHD: 2.51, 95% CI: 1.77?3.60, P < 0.001, ORhighest income tertile: 1.58, 95% CI: 1.06?2.23, P = 0.02, ORHF: 1.77, 95% CI: 1.35?2.32, P < 0.001). Implantable cardioverter defibrillator implantation was associated with a lower risk of mortality (HR: 0.70, 95% CI: 0.53?0.92, P = 0.01). Conclusion Implantable cardioverter defibrillator implantation rates increased over the study period. CHF, previous IHD and high income were associated with ICD implantation, while older age and non-shockable rhythm was associated with lower odds of ICD implantation. Implantable cardioverter defibrillator implantation was associated with higher survival rates.

Originalsprog	Engelsk
Tidsskrift	EP - Europace
Vol/bind	20
Udgave nummer	7
Sider (fra-til)	1129-1137
ISSN	1099-5129
DOI	https://doi.org/10.1093/europace/eux223
Status	Udgivet - 1. jul. 2018
Udgivet eksternt	Ja

Bibliografisk note

Funding Information:
This work was supported by a grant from the Research Committee at Rigshospitalet to MSc. Winther-Jensen. Dr Lippert reports unrestricted research grants from The Danish foundation TrygFonden and the Laerdal foundation. Dr Steen Hansen has received a research grant from the Danish Heart Foundation and the Laerdal Foundation. Dr Kragholm reports having received grants from The Laerdal Foundation, outside the present study. The Danish Out-of-hospital Cardiac Arrest Registry is supported by TrygFonden. Professor Christensen is supported by TrygFonden, through a non-personal grant to Aalborg University.

Funding Information:
Conflicts of interest: Dr Hassager reports personal lecture fee from Novartis, Orion, TEVA, and ViCare, outside the submitted work. Dr Kjaergaard reports personal lecture fees from Astra Zeneca, Orion Pharma and Bayer, outside the submitted work. Dr Lassen reports personal lecture fees from Astra Zeneca, and Boehringer Ingelheim outside the present study. Dr Kragholm reports having received speaker’s honorarium from Novartis. Professor Køber reports personal lecture fee outside this work from Novartis and Sanofi-Aventis. Professor Torp-Pedersen has received grants and speakers honoraria from Bayer and a grant from Biotronic, outside of the present study. All other authors report no conflicts of interest.

Publisher Copyright:
©The Author(s) 2018.

Finansiering

This work was supported by a grant from the Research Committee at Rigshospitalet to MSc. Winther-Jensen. Dr Lippert reports unrestricted research grants from The Danish foundation TrygFonden and the Laerdal foundation. Dr Steen Hansen has received a research grant from the Danish Heart Foundation and the Laerdal Foundation. Dr Kragholm reports having received grants from The Laerdal Foundation, outside the present study. The Danish Out-of-hospital Cardiac Arrest Registry is supported by TrygFonden. Professor Christensen is supported by TrygFonden, through a non-personal grant to Aalborg University. Conflicts of interest: Dr Hassager reports personal lecture fee from Novartis, Orion, TEVA, and ViCare, outside the submitted work. Dr Kjaergaard reports personal lecture fees from Astra Zeneca, Orion Pharma and Bayer, outside the submitted work. Dr Lassen reports personal lecture fees from Astra Zeneca, and Boehringer Ingelheim outside the present study. Dr Kragholm reports having received speaker’s honorarium from Novartis. Professor Køber reports personal lecture fee outside this work from Novartis and Sanofi-Aventis. Professor Torp-Pedersen has received grants and speakers honoraria from Bayer and a grant from Biotronic, outside of the present study. All other authors report no conflicts of interest.

Dokumenter og links

10.1093/europace/eux223

SDU link

Tjek adgangen til materialet i Syddansk Universitetsbiblioteks søgemaskine

Citationsformater

Winther-Jensen, M., Hassager, C., Lassen, J. F., Køber, L., Torp-Pedersen, C., Hansen, S. M., Lippert, F., Christensen, E. F., Kragholm, K., & Kjaergaard, J. (2018). Association between socioeconomic factors and ICD implantation in a publicly financed health care system: A Danish nationwide study. EP - Europace, 20(7), 1129-1137. https://doi.org/10.1093/europace/eux223

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title = "Association between socioeconomic factors and ICD implantation in a publicly financed health care system: A Danish nationwide study",

abstract = "Aims For patients surviving out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, implantable cardioverter defibrillator (ICD) is recommended for non-reversible causes of arrest. We aimed to determine factors associated with implantation of ICD and survival in patients surviving non-AMI OHCA in a nationwide register covering all OHCAs in Denmark. Methods and results We identified 36 950 OHCAs between 2001 and 2012, 1700 of whom were ICD nai?ve, >18 years, of non-AMI cardiac aetiology and surviving until discharge. Six hundred fifty eight patients had ICD implanted during index admission. Association to ICD implantation during index admission was analysed in logistic regression, survival was assessed using Cox regression. Implantable cardioverter defibrillator implantation increased during the study period [odds ratio (OR) 1-year increase: 1.04, 95\% confidence intervals (95\% CI): 1.00?1.08, P = 0.03]. Non-shockable rhythm and age >70 years were associated with lower odds of ICD implantation (ORnon-shockable: 0.27, 95\% CI: 0.19?0.37, P < 0.001, OR70?79 years: 0.71, 95\% CI: 0.52?0.98, P = 0.04, OR>80 years: 0.13, 95\% CI: 0.07?0.22, P < 0.001). Non-AMI ischaemic heart disease, highest income tertile and chronic heart failure were associated with higher odds (ORIHD: 2.51, 95\% CI: 1.77?3.60, P < 0.001, ORhighest income tertile: 1.58, 95\% CI: 1.06?2.23, P = 0.02, ORHF: 1.77, 95\% CI: 1.35?2.32, P < 0.001). Implantable cardioverter defibrillator implantation was associated with a lower risk of mortality (HR: 0.70, 95\% CI: 0.53?0.92, P = 0.01). Conclusion Implantable cardioverter defibrillator implantation rates increased over the study period. CHF, previous IHD and high income were associated with ICD implantation, while older age and non-shockable rhythm was associated with lower odds of ICD implantation. Implantable cardioverter defibrillator implantation was associated with higher survival rates.",

keywords = "Implantable cardioverter-defibrillator, Out-of-hospital cardiac arrest, Post resuscitation care, Socioeconomic factors, Age Factors, Humans, Middle Aged, Income, Male, Public Sector/economics, Socioeconomic Factors, Financing, Government, Young Adult, Time Factors, Aged, 80 and over, Adult, Female, Registries, Retrospective Studies, Delivery of Health Care/economics, Out-of-Hospital Cardiac Arrest/diagnosis, Comorbidity, Risk Factors, Treatment Outcome, Defibrillators, Implantable/adverse effects, Electric Countershock/adverse effects, Denmark/epidemiology, Health Care Costs, Adolescent, Aged, Health Status",

author = "Matilde Winther-Jensen and Christian Hassager and Lassen, \{Jens Flensted\} and Lars K{\o}ber and Christian Torp-Pedersen and Hansen, \{Steen M{\o}ller\} and Freddy Lippert and Christensen, \{Erika Frischknecht\} and Kristian Kragholm and Jesper Kjaergaard",

note = "Publisher Copyright: {\textcopyright}The Author(s) 2018.",

year = "2018",

month = jul,

day = "1",

doi = "10.1093/europace/eux223",

language = "English",

volume = "20",

pages = "1129--1137",

journal = "EP - Europace",

issn = "1099-5129",

publisher = "Oxford University Press",

number = "7",

}

TY - JOUR

T1 - Association between socioeconomic factors and ICD implantation in a publicly financed health care system

T2 - A Danish nationwide study

AU - Winther-Jensen, Matilde

AU - Hassager, Christian

AU - Lassen, Jens Flensted

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Hansen, Steen Møller

AU - Lippert, Freddy

AU - Christensen, Erika Frischknecht

AU - Kragholm, Kristian

AU - Kjaergaard, Jesper

N1 - Publisher Copyright: ©The Author(s) 2018.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Aims For patients surviving out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, implantable cardioverter defibrillator (ICD) is recommended for non-reversible causes of arrest. We aimed to determine factors associated with implantation of ICD and survival in patients surviving non-AMI OHCA in a nationwide register covering all OHCAs in Denmark. Methods and results We identified 36 950 OHCAs between 2001 and 2012, 1700 of whom were ICD nai?ve, >18 years, of non-AMI cardiac aetiology and surviving until discharge. Six hundred fifty eight patients had ICD implanted during index admission. Association to ICD implantation during index admission was analysed in logistic regression, survival was assessed using Cox regression. Implantable cardioverter defibrillator implantation increased during the study period [odds ratio (OR) 1-year increase: 1.04, 95% confidence intervals (95% CI): 1.00?1.08, P = 0.03]. Non-shockable rhythm and age >70 years were associated with lower odds of ICD implantation (ORnon-shockable: 0.27, 95% CI: 0.19?0.37, P < 0.001, OR70?79 years: 0.71, 95% CI: 0.52?0.98, P = 0.04, OR>80 years: 0.13, 95% CI: 0.07?0.22, P < 0.001). Non-AMI ischaemic heart disease, highest income tertile and chronic heart failure were associated with higher odds (ORIHD: 2.51, 95% CI: 1.77?3.60, P < 0.001, ORhighest income tertile: 1.58, 95% CI: 1.06?2.23, P = 0.02, ORHF: 1.77, 95% CI: 1.35?2.32, P < 0.001). Implantable cardioverter defibrillator implantation was associated with a lower risk of mortality (HR: 0.70, 95% CI: 0.53?0.92, P = 0.01). Conclusion Implantable cardioverter defibrillator implantation rates increased over the study period. CHF, previous IHD and high income were associated with ICD implantation, while older age and non-shockable rhythm was associated with lower odds of ICD implantation. Implantable cardioverter defibrillator implantation was associated with higher survival rates.

AB - Aims For patients surviving out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, implantable cardioverter defibrillator (ICD) is recommended for non-reversible causes of arrest. We aimed to determine factors associated with implantation of ICD and survival in patients surviving non-AMI OHCA in a nationwide register covering all OHCAs in Denmark. Methods and results We identified 36 950 OHCAs between 2001 and 2012, 1700 of whom were ICD nai?ve, >18 years, of non-AMI cardiac aetiology and surviving until discharge. Six hundred fifty eight patients had ICD implanted during index admission. Association to ICD implantation during index admission was analysed in logistic regression, survival was assessed using Cox regression. Implantable cardioverter defibrillator implantation increased during the study period [odds ratio (OR) 1-year increase: 1.04, 95% confidence intervals (95% CI): 1.00?1.08, P = 0.03]. Non-shockable rhythm and age >70 years were associated with lower odds of ICD implantation (ORnon-shockable: 0.27, 95% CI: 0.19?0.37, P < 0.001, OR70?79 years: 0.71, 95% CI: 0.52?0.98, P = 0.04, OR>80 years: 0.13, 95% CI: 0.07?0.22, P < 0.001). Non-AMI ischaemic heart disease, highest income tertile and chronic heart failure were associated with higher odds (ORIHD: 2.51, 95% CI: 1.77?3.60, P < 0.001, ORhighest income tertile: 1.58, 95% CI: 1.06?2.23, P = 0.02, ORHF: 1.77, 95% CI: 1.35?2.32, P < 0.001). Implantable cardioverter defibrillator implantation was associated with a lower risk of mortality (HR: 0.70, 95% CI: 0.53?0.92, P = 0.01). Conclusion Implantable cardioverter defibrillator implantation rates increased over the study period. CHF, previous IHD and high income were associated with ICD implantation, while older age and non-shockable rhythm was associated with lower odds of ICD implantation. Implantable cardioverter defibrillator implantation was associated with higher survival rates.

KW - Implantable cardioverter-defibrillator

KW - Out-of-hospital cardiac arrest

KW - Post resuscitation care

KW - Socioeconomic factors

KW - Age Factors

KW - Humans

KW - Middle Aged

KW - Income

KW - Male

KW - Public Sector/economics

KW - Socioeconomic Factors

KW - Financing, Government

KW - Young Adult

KW - Time Factors

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Registries

KW - Retrospective Studies

KW - Delivery of Health Care/economics

KW - Out-of-Hospital Cardiac Arrest/diagnosis

KW - Comorbidity

KW - Risk Factors

KW - Treatment Outcome

KW - Defibrillators, Implantable/adverse effects

KW - Electric Countershock/adverse effects

KW - Denmark/epidemiology

KW - Health Care Costs

KW - Adolescent

KW - Aged

KW - Health Status

U2 - 10.1093/europace/eux223

DO - 10.1093/europace/eux223

M3 - Journal article

C2 - 29016817

AN - SCOPUS:85051064224

SN - 1099-5129

VL - 20

SP - 1129

EP - 1137

JO - EP - Europace

JF - EP - Europace

IS - 7

ER -

Association between socioeconomic factors and ICD implantation in a publicly financed health care system: A Danish nationwide study

Abstract

Bibliografisk note

Finansiering

Dokumenter og links

SDU link

Fingeraftryk

Citationsformater