Health care utilisation after defibrillator implantation for primary prevention according to the guidelines in 2 Dutch academic medical centres
Background The benefit of implantable defibrillators (ICDs) for primary prevention remains debated. We analysed the implications of prophylactic ICD implantation according to the guidelines in 2 tertiary hospitals, and made a healthcare utilisation inventory. Methods The cohort consisted of all consecutive patients with coronary artery disease (CAD) or dilated cardiomyopathy (DCM) receiving a primary prophylactic ICD in a contemporary setting (2004-2008). Follow-up was obtained from hospital databases, and mortality checked at the civil registry. Additional data came from questionnaires sent to general practitioners. Results There were no demographic differences between the 2 centres; one had proportionally more CAD patients and more resynchronisation therapy (CRT-D). The 587 patients were followed over a median of 28 months, and 50 (8.5%) patients died. Appropriate ICD intervention occurred in 123 patients (21%). There was a small difference in interventionfree survival between the 2 centres. The questionnaires revealed 338 hospital admissions in 52% of the responders. Device-related admissions happened on 68 occasions, in 49/ 276 responders. The most frequently reported ICD-related admission was due to shocks (20/49 patients); for other cardiac problems it was mainly heart failure (52/99). Additional outpatient visits occurred in 19%. Conclusion Over a median follow-up of 2 years, one fifth of prophylactic ICD patients receive appropriate interventions. A substantial group undergoes readmission and additional visits. The high number of admissions points to a very ill population. Overall mortality was 8.5%. The 2 centres employed a similar procedure with respect to patient selection. One centre used more CRT-D, and observed more appropriate ICD interventions.
|Keywords||Complications, Coronary artery disease, Dilated cardiomyopathy, Health care resources, Implantable cardioverter defibrillator, Mortality, Primary prevention, Sudden cardiac death, Ventricular arrhythmias|
|Persistent URL||dx.doi.org/10.1007/s12471-011-0176-3, hdl.handle.net/1765/34417|
Smith, T., van Pascal, P.F.H.M., Theuns, D.A.M.J., Muskens-Heemskerk, A., van Domburg, R.T., Wilde, A.A.M., & Jordaens, L.J.L.M.. (2011). Health care utilisation after defibrillator implantation for primary prevention according to the guidelines in 2 Dutch academic medical centres. Netherlands Heart Journal, 19(10), 405–411. doi:10.1007/s12471-011-0176-3