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.

Complications, Coronary artery disease, Dilated cardiomyopathy, Health care resources, Implantable cardioverter defibrillator, Mortality, Primary prevention, Sudden cardiac death, Ventricular arrhythmias,
Netherlands Heart Journal
Erasmus MC: University Medical Center Rotterdam

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