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Published on: February 28, 2012
Hospital readmission after transvenous cardioverter/defibrillator implantation; a single centre study
1Departments of Cardiology, University of Bonn, Bonn, Germany.
Insights
Hospital readmission rates are high following cardioverter/defibrillator implantation, with shock interventions and device complications being primary causes. Patients over 60 experience longer rehospitalization times, highlighting a need for preventative strategies.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- Hospital readmission significantly impacts patient quality of life and healthcare costs.
- Modern transvenous cardioverter/defibrillator systems are widely used, but rehospitalization patterns require further investigation in large cohorts.
Purpose of the Study:
- To determine the incidence, reasons, duration, and predictors of hospital readmission after transvenous cardioverter/defibrillator implantation.
- To analyze rehospitalization trends in a large patient population with contemporary defibrillation systems.
Main Methods:
- Retrospective analysis of 180 patients undergoing transvenous cardioverter/defibrillator implantation.
- Follow-up period of 25±18 months to track readmission rates, causes, and duration.
- Statistical analysis to identify predictors of rehospitalization, including patient age.
Main Results:
- A total of 156 readmissions occurred in 79 patients, with a readmission rate of 0.46 per patient-year.
- Leading causes included appropriate shock interventions (26%), battery depletion (19%), and lead/device complications (14%).
- Patients over 60 years old showed a significantly longer rehospitalization duration (P<0.005).
Conclusions:
- Modern cardioverter/defibrillator therapy is associated with a substantial hospital readmission rate of 0.46 per patient-year.
- Appropriate shock treatments are a major driver of rehospitalization.
- Preventative strategies for rehospitalization in patients with implantable cardioverter-defibrillators warrant further investigation, particularly for older patient cohorts.
Aims:
Hospital readmission after implantation of cardioverter/defibrillators has a major impact on quality of life and cost-effectiveness in defibrillator patients. Rehospitalization has not been studied in large patient populations with modern transvenous defibrillation systems.
Methods And Results:
We report on incidence, reasons, time in follow-up, duration and predictors of hospital readmission in 180 patients after transvenous implantation of a cardioverter/defibrillator during a follow-up period of 25+/-18 months. There were 156 readmissions in 79 patients with a 0.87 readmission rate per patient during the time followed, a 0.46 readmission rate per patient-year of follow-up and a 0.38 readmission rate per patient-year of follow-up for cardiac reasons. The majority of readmissions was caused by multiple appropriate shock interventions (26%), battery depletion (19%) and lead- and device-related complications (14%). The time to first hospital readmission was 12+/-9 months for arrhythmia-related and 20+/-16 months for other cardiac-related reasons (P<0.05), and could not be predicted by clinical variables, respectively. The duration of rehospitalization was 14+/-15 days for cardiac-related reasons and 12+/-17 days for arrhythmia-related reasons. Age >60 years was an independent predictor of rehospitalization time per patient-year of follow-up for both cardiac-related (P<0.005) and arrhythmia-related reasons (P<0.05).
Conclusion:
The rate of hospital readmission per patient-year of follow-up is as high as 0.46 after implantation of a modern cardioverter/defibrillator. Rehospitalization time in such patients is significantly longer in the patient cohort >60 years. The majority of readmissions is caused by multiple appropriate shock treatments. Further studies are needed to systematically investigate strategies for the prevention of rehospitalization in modern ICD therapy.
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