DOES THE ICD IMPLANTATION RATE VARY BASED ON LOCAL HEALTH AUTHORITY IN BRITISH COLUMBIA?

BackgroundImplantable Cardioverter Defibrillators (ICDs) reduces mortality in people with cardiomyopathy. Despite this proven efficacy, data suggests that there is significant unmet need in most advanced health care systems. Data from the Canadian Institute for Health Information has demonstrated that there is significant inter- and intra-provincial variability with respect to implant rates. Reasons explaining this, however; have not yet been identified. Appropriate and equitable access to life-saving cardiac therapies is a key priority area for Cardiac Services BC and the BC Ministry of Health. Unfortunately, the true distribution of need for ICDs is difficult to define. The use of surrogate markers of need (ie. rates of underlying cardiac conditions often associated with ICD implantation) might be informative to raise awareness of regional variation and begin to explain the geographical distribution observed throughout the province. High level screening of the disparity between potential need and access can inform provincial decision making regarding future investment into projects focusing on identifying sources of unexplained variation.MethodsA retrospective analysis was performed using data from the Cardiac Services BC Registry and included BC residents ≥ 20 years of age who underwent implantation of a new ICD/CRT-D in BC between 2001- 2013. GIS software was used to map ICD implantation rates by local health authority (LHA). Surrogate markers for the eligible population in need of an ICD, such as the incidence of heart failure (CHF) and rates of acute myocardial infarction (AMI), and the ICD implantation rates as a proportion of AMI and CHF incidence were also mapped by LHA. In addition, ICD implant rates were mapped to LHA socio-economic status.Results4249 patients were included. The LHA ICD implantation rate was 70-3350 per 1,000,000. 0-12% of AMI incident diagnosis and 0-7% of CHF incident diagnosis received an ICD. The rate of ICD implantation was higher in urban compared with rural communities 2.7% vs 2.1% of heart failure diagnosis and 5.3% vs 3.6% of AMI diagnosis.Conclusion BackgroundImplantable Cardioverter Defibrillators (ICDs) reduces mortality in people with cardiomyopathy. Despite this proven efficacy, data suggests that there is significant unmet need in most advanced health care systems. Data from the Canadian Institute for Health Information has demonstrated that there is significant inter- and intra-provincial variability with respect to implant rates. Reasons explaining this, however; have not yet been identified. Appropriate and equitable access to life-saving cardiac therapies is a key priority area for Cardiac Services BC and the BC Ministry of Health. Unfortunately, the true distribution of need for ICDs is difficult to define. The use of surrogate markers of need (ie. rates of underlying cardiac conditions often associated with ICD implantation) might be informative to raise awareness of regional variation and begin to explain the geographical distribution observed throughout the province. High level screening of the disparity between potential need and access can inform provincial decision making regarding future investment into projects focusing on identifying sources of unexplained variation. Implantable Cardioverter Defibrillators (ICDs) reduces mortality in people with cardiomyopathy. Despite this proven efficacy, data suggests that there is significant unmet need in most advanced health care systems. Data from the Canadian Institute for Health Information has demonstrated that there is significant inter- and intra-provincial variability with respect to implant rates. Reasons explaining this, however; have not yet been identified. Appropriate and equitable access to life-saving cardiac therapies is a key priority area for Cardiac Services BC and the BC Ministry of Health. Unfortunately, the true distribution of need for ICDs is difficult to define. The use of surrogate markers of need (ie. rates of underlying cardiac conditions often associated with ICD implantation) might be informative to raise awareness of regional variation and begin to explain the geographical distribution observed throughout the province. High level screening of the disparity between potential need and access can inform provincial decision making regarding future investment into projects focusing on identifying sources of unexplained variation. MethodsA retrospective analysis was performed using data from the Cardiac Services BC Registry and included BC residents ≥ 20 years of age who underwent implantation of a new ICD/CRT-D in BC between 2001- 2013. GIS software was used to map ICD implantation rates by local health authority (LHA). Surrogate markers for the eligible population in need of an ICD, such as the incidence of heart failure (CHF) and rates of acute myocardial infarction (AMI), and the ICD implantation rates as a proportion of AMI and CHF incidence were also mapped by LHA. In addition, ICD implant rates were mapped to LHA socio-economic status. A retrospective analysis was performed using data from the Cardiac Services BC Registry and included BC residents ≥ 20 years of age who underwent implantation of a new ICD/CRT-D in BC between 2001- 2013. GIS software was used to map ICD implantation rates by local health authority (LHA). Surrogate markers for the eligible population in need of an ICD, such as the incidence of heart failure (CHF) and rates of acute myocardial infarction (AMI), and the ICD implantation rates as a proportion of AMI and CHF incidence were also mapped by LHA. In addition, ICD implant rates were mapped to LHA socio-economic status. Results4249 patients were included. The LHA ICD implantation rate was 70-3350 per 1,000,000. 0-12% of AMI incident diagnosis and 0-7% of CHF incident diagnosis received an ICD. The rate of ICD implantation was higher in urban compared with rural communities 2.7% vs 2.1% of heart failure diagnosis and 5.3% vs 3.6% of AMI diagnosis. 4249 patients were included. The LHA ICD implantation rate was 70-3350 per 1,000,000. 0-12% of AMI incident diagnosis and 0-7% of CHF incident diagnosis received an ICD. The rate of ICD implantation was higher in urban compared with rural communities 2.7% vs 2.1% of heart failure diagnosis and 5.3% vs 3.6% of AMI diagnosis. Conclusion