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To the Editor: Dr Curtis and colleagues¹ studied the association of physician certification and outcomes among patients receiving an implantable cardioverter-defibrillator (ICD). The authors suggested reappraisal of the need for and methods of training nonelectrophysiologists to implant ICDs if their findings of increased risk of procedural complications and decreased implantation of indicated biventricular pacemakers are confirmed.

However, there was no statistically significant increased risk in complications for the category of other specialists among all patients (relative risk [RR], 1.09; 95% confidence interval [CI], 0.94-1.26) or for nonelectrophysiologist cardiologists among the Medicare and Medicaid patients who made up 75% of their patient population (RR, 1.07; 95% CI, 0.97-1.17). Similarly, the decrease in the use of resynchronization for other specialists and for nonelectrophysiologist cardiologists was small among Medicare and Medicaid patients (RR, 0.97; 95% CI, 0.94-1.00, and RR, 0.93; 95% CI, 0.91-0.95, respectively).

We believe that these data support directing such reappraisal . . . [Full Text of this Article]

Jalal K. Ghali, MD
jghali@dmc.org

Theodore L. Schreiber, MD
Cardiovascular Institute
Detroit Medical Center
Detroit, Michigan

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Association of Physician Certification and Outcomes Among Patients Receiving an Implantable Cardioverter-Defibrillator
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