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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Healthcare Utilization and Expenditures Associated With Appropriate and Inappropriate Implantable Defibrillator
Mintu P Turakhia1, Steven Zweibel2, Andrea L Swain2
1From the Center for Digital Health, Stanford University School of Medicine, Stanford, CA (M.P.T.); the Division of Cardiac Electrophysiology, Hartford Healthcare Heart and Vascular Institute, Hartford, CT (S.Z.); the Department of Economics, Reimbursement, and Evidence, Medtronic plc, Mounds View, MN (A.L.S., S.A.M.); and Baim Institute for Clinical Research, Boston, MA (M.R.R.). mintu@stanford.edu.
Insights
Healthcare utilization after implantable cardioverter-defibrillator shocks is common, with many patients requiring outpatient visits or hospitalization. Reducing shocks could lead to significant cost savings.
Area of Science:
- Cardiology
- Health Economics
- Medical Device Research
Background:
- Healthcare utilization (HCU) and expenditures associated with implantable cardioverter-defibrillator (ICD) shocks remain unquantified.
- ICDs are crucial for managing arrhythmias, but device shocks can lead to significant healthcare resource use.
Purpose of the Study:
- To quantify healthcare utilization and expenditures following ICD shocks.
- To differentiate HCU and costs based on shock appropriateness (appropriate vs. inappropriate).
Main Methods:
- Retrospective cohort study using linked commercial and Medicare claims data.
- Identified patients with ICDs and adjudicated shock events via remote monitoring.
- Assessed HCU within 7 days post-shock, classifying shocks and quantifying associated costs.
Main Results:
- Of 10,266 patients, 9.4% experienced 1885 shocks (56% appropriate, 38% inappropriate).
- 46% of shocks were followed by HCU (14% inpatient, 32% outpatient).
- Common procedures included echocardiography, electrophysiology study/ablation, and cardiac catheterization; expenditures did not differ significantly between appropriate and inappropriate shocks.
Conclusions:
- ICD shocks frequently lead to subsequent healthcare utilization, including hospitalizations.
- Invasive cardiovascular procedures are common even after inappropriate shocks.
- Reducing ICD shocks may offer substantial cost savings and decrease patient HCU.
Background:
In patients with implantable cardioverter-defibrillators, healthcare utilization (HCU) and expenditures related to shocks have not been quantified.
Methods And Results:
We performed a retrospective cohort study of patients with implantable cardioverter-defibrillators identified from commercial and Medicare supplemental claims databases linked to adjudicated shock events from remote monitoring data. A shock event was defined as ≥1 spontaneous shocks delivered by an implanted device. Shock-related HCU was ascertained from inpatient and outpatient claims within 7 days following a shock event. Shock events were adjudicated and classified as inappropriate or appropriate, and HCU and expenditures, stratified by shock type, were quantified. Of 10 266 linked patients, 963 (9.4%) patients (61.3±13.6 years; 81% male) had 1885 shock events (56% appropriate, 38% inappropriate, and 6% indeterminate). Of these events, 867 (46%) had shock-related HCU (14% inpatient and 32% outpatient). After shocks, inpatient cardiovascular procedures were common, including echocardiography (59%), electrophysiology study or ablation (34%), stress testing (16%), and lead revision (11%). Cardiac catheterization was common (71% and 51%), but percutaneous coronary intervention was low (6.5% and 5.0%) after appropriate and inappropriate shocks. Expenditures related to appropriate and inappropriate shocks were not significantly different.
Conclusions:
After implantable cardioverter-defibrillator shock, related HCU was common, with 1 in 3 shock events followed by outpatient HCU and 1 in 7 followed by hospitalization. Use of invasive cardiovascular procedures was substantial, even after inappropriate shocks, which comprised 38% of all shocks. Implantable cardioverter-defibrillator shocks seem to trigger a cascade of health care. Strategies to reduce shocks could result in cost savings.
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