Implantable Cardioverter-Defibrillator Use Among Medicare @entity1 With Low Ejection Fraction After Acute XXXX .

@entity1 @entity1479 @entity737 @entity583 @entity1455
IMPORTANCE: @entity737 ( @entity737 ) are not recommended within 40 days of @entity583 ( @entity583 ); thus, @entity1479 implantation might not be considered during the post- @entity583 care transition. OBJECTIVE: To examine @entity1479 implantation rates and associated mortality among older @entity583 @entity1 with low ejection fraction (EF). DESIGN, SETTING, AND @entity1 : Retrospective observational study of Medicare beneficiaries with an EF of 35% or less after @entity583 , treated at 441 US hospitals between 2007 and 2010, excluding @entity1 with prior @entity1479 implantation. Follow-up data were available through December 2010. EXPOSURES: @entity1479 implantation within 1 year of @entity583 vs no @entity1479 implantation within 1 year of @entity583 . MAIN OUTCOMES AND MEASURES: @entity1 characteristics associated with receiving an @entity1479 within 1 year after discharge and 2-year mortality associated with @entity1479 implantation. RESULTS: Among 10,318 @entity583 @entity1 with EF of 35%or lower, the cumulative 1-year @entity1479 implantation rate was 8.1% (95%CI, 7.6%-8.7%). @entity1 with @entity1479 implantation were more likely to have prior coronary artery bypass graft procedures, higher peak troponin levels, in-hospital @entity1455 , and cardiology follow-up within 2 weeks after discharge relative to @entity1 who did not receive an @entity1479 within 1 year. Implantation of @entity1479 was associated with lower 2-year mortality (15.3 events per 100 @entity1 -years [128 deaths in 838 @entity1 -years] vs 26.4 events per 100 @entity1 -years [3033 deaths in 11 479 @entity1 -years]; adjusted HR, 0.64; 95%CI, 0.53-0.78). [table: see text] CONCLUSIONS AND RELEVANCE: In this large registry study of older @entity1 who experienced @entity583 from 2007-2010, fewer than 1 in 10 eligible @entity1 with low EF received an @entity1479 within 1 year after @entity583 , although @entity1479 implantation was associated with lower risk-adjusted mortality at 2 years. Additional research is needed to determine evidence-based approaches to increase @entity1479 implantation among eligible @entity1 .
