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Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs.
We conducted a case-control analysis of ICD patients at a single institution from 1997-2010 and who had ≥12 months of post-ICD implant follow up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year (PY)) of healthcare utilization immediately following IAS to the end of the 12 month follow up period to the rate in the no shock group over 12 months of follow up. We also compared 12 month post-implant treatment (clinic, emergency room and hospitalization) costs in both groups.
A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no shock patients (contributing 76 PYs). Mean age of the population was 61±14 years, 65% were male and 67% received an ICD for primary prevention. Cardiovascular-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (3.96 vs. 3.29 and 0.71 vs. 0.45, respectively, p≤0.05 for both). Cardiovascular-related emergency room (0.15 vs. 0.08) and hospitalization rates (0.38 vs. 0.29) were also numerically higher following an IAS, but did not reach statistical significance (p≥0.26 for both). Patients experiencing an IAS accrued greater treatment costs during the 12 months post-implant compared to no shock patients ($25,876±63,133 vs. $12,167±30,647, p=0.001).
Patients appear to utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization likely explains our observation of higher cost of treating IAS patients during the 12 months post-implant.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmia Outcomes and Quality Assessment
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1245-112
- 2013 American College of Cardiology Foundation