Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators

Saman Nazarian, Matthew R Reynolds, Michael P Ryan, Steven D Wolff, Sarah A Mollenkopf, Mintu P Turakhia, Saman Nazarian, Matthew R Reynolds, Michael P Ryan, Steven D Wolff, Sarah A Mollenkopf, Mintu P Turakhia

Abstract

Purpose: To examine imaging utilization in a matched cohort of patients with and without implantable cardioverter defibrillators (ICD) and to project magnetic resonance imaging (MRI) utilization over a 10-year period.

Materials and methods: The Truven Health MarketScan Commercial claims and Medicare Supplemental health insurance claims data were used to identify patients with continuous health plan enrollment in 2009-2012. Patients with ICDs were identified using ICD-9 and CPT codes, and matched to patients with the same demographic and comorbidity profile, but no record of device implantation. Diagnostic imaging utilization was compared across the matched cohorts, in total, by imaging categories, and in subpopulations of stroke, back pain, and joint pain. MRI use in the nonimplant group over the 4-year period was extrapolated out to 10 years for ICD-indicated patients.

Results: A cohort of 18,770 matched patients were identified; average age 65.5 ± 13.38 and 21.9% female. ICD patients had significantly less MRI imaging (0.23 0.70 SD vs. 0.00 0.08 SD, P < 0.0001) than nonimplant patients. Among patients with records of stroke/transient ischemic attack (TIA) (ICD 5%, nonimplant 4%) and accompanying diagnostic imaging, 44% of nonimplant patients underwent MRI vs. 1% of ICD patients (P < 0.0001). Forecast models estimated that 53% to 64% of ICD-eligible patients may require an MRI within 10 years.

Conclusion: MRI utilization is lower in ICD patients compared to nonimplant patients, yet the burden of incident stroke/TIA, back, and joint pain suggests an unmet need for MR-conditional devices.

Keywords: defibrillation; healthcare utilization; heart-assist device; implantable cardioverter defibrillators; magnetic resonance imaging.

© 2015 The Authors Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.

Figures

Figure 1
Figure 1
Patient attrition diagram. ICD: implantable cardioverter defibrillator.
Figure 2
Figure 2
A: Total number of procedures for each cohort by radiology category. B: Number of patients for each cohort by radiology category. ICD: implantable cardioverter defibrillator; CT: computed tomography; CTA: computed tomography angiography; MRI: magnetic resonance imaging; MRA: magnetic resonance angiogram.
Figure 3
Figure 3
A: Percentage of patients with stroke/TIA event by radiology type. B: Percentage of patients with back pain by radiology type. C: Percentage of patients with joint pain by radiology type. ICD: implantable cardioverter defibrillator; CT: computed tomography; CTA: computed tomography angiography; MRI: magnetic resonance imaging; MRA: magnetic resonance angiogram.
Figure 4
Figure 4
MRI/MRA use by ICD‐indicated patients and projected utilization to 10 years. The black line represents the proportion of ICD‐indicated patients who received an MRI or MRA at 1, 2, 3, and 4 years. The lines extending after year 4 show two projections, which are high and low estimates of utilization. MRI: magnetic resonance imaging; MRA: magnetic resonance angiogram; ICD: implantable cardioverter defibrillator.

References

    1. Medpac: Medicare Payment Advisory Commission. A Data Book. Health Care Spending and the Medicare Program. June, 2014.
    1. United States Government Accountability Office. Medicare Part B Imaging Services. Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices. GAO‐08–452. June, 2008.
    1. Smith‐Bindman R, Miglioretti DL, Larson EB. Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood) 2008;27:1491–1502.
    1. Kalin R, Stanton MS. Current clinical issues for MRI scanning of pacemaker and defibrillator patients. Pacing Clin Electrophysiol 2005;28:326–328.
    1. American College of Radiology. ACR Appropriateness Criteria®. .
    1. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870–947.
    1. Schellinger PD, Bryan RN, Caplan LR, et al. Evidence‐based guideline: the role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010;75:177–185.
    1. Wintermark M, Sanelli PC, Albers GW, et al. Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. AJNR Am J Neuroradiol 2013;34:E117–127.
    1. Roguin A, Schwitter J, Vahlhaus C, et al. Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices. Europace 2008;10:336–346.
    1. Marcu CB, Beek AM, van Rossum AC. Clinical applications of cardiovascular magnetic resonance imaging. CMAJ 2006;175:911–917.
    1. Gotte MJ, Russel IK, de Roest GJ, et al. Magnetic resonance imaging, pacemakers and implantable cardioverter‐defibrillators: current situation and clinical perspective. Neth Heart J 2010;18:31–37.
    1. Nazarian S, Halperin HR. How to perform magnetic resonance imaging on patients with implantable cardiac arrhythmia devices. Heart Rhythm 2009;6:138–143.
    1. Levine GN, Gomes AS, Arai AE, et al. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American Heart Association scientific statement from the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: endorsed by the American College of Cardiology Foundation, the North American Society for Cardiac Imaging, and the Society for Cardiovascular Magnetic Resonance. Circulation 2007;116:2878–2891.
    1. Nazarian S, Beinart R, Halperin HR. Magnetic resonance imaging and implantable devices. Circ Arrhythm Electrophysiol 2013;6:419–428.
    1. Greenspon AJ, Patel JD, Lau E, et al. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures. J Am Coll Cardiol 2012;60:1540–1545.
    1. Kremers MS, Hammill SC, Berul CI, et al. The National ICD Registry Report: version 2.1 including leads and pediatrics for years 2010 and 2011. Heart Rhythm 2013;10:e59–65.
    1. U.S. Food and Drug Administration. A Primer on Medical Device Interactions with Magnetic Resonance Imaging Systems. .
    1. Verma A, Ha AC, Dennie C, et al. Canadian heart rhythm society and canadian association of radiologists consensus statement on magnetic resonance imaging with cardiac implantable electronic devices. Can J Cardiol 2014;30:1131–1141.
    1. Nazarian S, Hansford R, Roguin A, et al. A prospective evaluation of a protocol for magnetic resonance imaging of patients with implanted cardiac devices. Ann Intern Med 2011;155:415–424.
    1. Cohen JD, Costa HS, Russo RJ. Determining the risks of magnetic resonance imaging at 1.5 Tesla for patients with pacemakers and implantable cardioverter defibrillators. Am J Cardiol 2012;110:1631–1636.
    1. Breslin TM, Banerjee M, Gust C, Birkmeyer NJ. Trends in advanced imaging use for women undergoing breast cancer surgery. Cancer 2013;119:1251–1256.
    1. Lee DW, Foster DA. The association between hospital outcomes and diagnostic imaging: early findings. J Am Coll Radiol 2009;6:780–785.
    1. Mayo Clinic. Gmatch macro developed by Erik Bergstralh and Jon Kosanke. 2003 .
    1. Parsons LS. Reducing Bias in a Propensity Score Matched‐Pair Sample Using Greedy Matching Techniques. Paper presented at the Proceedings of the 26th Annual SAS Users Group International Conference. 2001. .
    1. Lang K, Huang H, Lee DW, Federico V, Menzin J. National trends in advanced outpatient diagnostic imaging utilization: an analysis of the medical expenditure panel survey, 2000–2009. BMC Med Imaging 2013;13:40.
    1. Levin DC, Rao VM, Parker L. Trends in the utilization of outpatient advanced imaging after the deficit reduction act. J Am Coll Radiol 2012;9:27–32.
    1. Marinskis G, Bongiorni MG, Dagres N, Dobreanu D, Lewalter T, Blomstrom‐Lundqvist C. Performing magnetic resonance imaging in patients with implantable pacemakers and defibrillators: results of a European Heart Rhythm Association survey. Europace 2012;14:1807–1809.
    1. Russo RJ. Determining the Risks of Magnetic Resonance Imaging at 1.5 Tesla for Patients with Non‐MRI Conditional Pacemakers and Implantable Cardioverter Defibrillators: Final Results of The MagnaSafe Registry. Presentation at American Heart Association Scientific Sessions 2014: November 18, 2014 Chicago, IL.
    1. van der Graaf AW, Bhagirath P, Gotte MJ. MRI and cardiac implantable electronic devices; current status and required safety conditions. Neth Heart J 2014;22:269–276.
    1. Brignole M, Auricchio A, Baron‐Esquivias G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 2013;15:1070–1118.

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