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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Increased Hospitalizations and Overall Healthcare Utilization in Patients Receiving Implantable
Prashanthan Sanders1, Allison T Connolly2, Yelena Nabutovsky2
1Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Insights
Antitachycardia pacing (ATP) for implantable cardioverter-defibrillators (ICDs) reduced hospitalizations and costs compared to shocks. Patients receiving ATP only had similar outcomes to those receiving no therapy, highlighting ATP
Area of Science:
- Cardiology
- Medical Device Technology
- Health Economics
Background:
- Antitachycardia pacing (ATP) terminates ventricular tachycardia, potentially avoiding high-voltage shocks from implantable cardioverter-defibrillators (ICDs).
- Limited data exist on the comparative healthcare resource utilization between ATP and shock therapies in ICD patients.
Purpose of the Study:
- To evaluate the impact of different ICD therapies (no therapy, ATP only, shocks) on healthcare utilization in a large primary prevention cohort.
- To compare cardiac hospitalizations, mortality risk, and healthcare costs among these therapy groups.
Main Methods:
- Analysis of the prospective PROVIDE study (N=1,670) involving ICD implantation for primary prevention.
- Patients were categorized by therapy received: no therapy, ATP only, or at least one shock.
- Adjudication of ICD therapies, hospitalizations, and deaths; comparison of cumulative hospitalizations, all-cause death/cardiac hospitalization risk, and annual costs.
Main Results:
- Patients receiving no therapy (1,316) or ATP only (152) had significantly lower cumulative hospitalization rates and risk of death or hospitalization compared to those receiving shocks (202).
- Hospitalization costs were $2,874/patient-year higher for patients receiving at least one shock versus ATP only.
- No significant differences in outcomes or costs were observed between patients receiving ATP only and those receiving no therapy.
Conclusions:
- For primary prevention ICD patients, ATP therapy alone is associated with reduced hospitalizations, mortality, and costs compared to high-voltage shocks.
- ATP therapy offers equivalent outcomes and cost-effectiveness to no therapy in this patient population.
Objectives:
The purpose of this study was to evaluate the effect of these therapies on healthcare utilization in a large patient cohort.
Background:
Antitachycardia pacing (ATP) terminates ventricular tachycardia and avoids delivery of high-voltage shocks. Few data exist on the impact of shocks on healthcare resource utilization compared with ATP.
Methods:
PROVIDE (Programming Implantable Cardioverter Defibrillators in Patients With Primary Prevention Indication) was a prospective study of patients who received an implantable cardioverter-defibrillator (ICD) for primary prevention at 97 U.S. centers (2008 to 2010). We categorized the PROVIDE patients by the type of therapy delivered: no therapy, ATP only, or at least 1 shock. All ICD therapies, hospitalizations, and deaths were adjudicated. Cumulative cardiac hospitalizations, risk of all-cause death or cardiac hospitalization, and annual costs were compared between groups.
Results:
Of the 1,670 patients in PROVIDE, followed up for 18.1 ± 7.6 months, 1,316 received no therapy, 152 had ATP only, and 202 received at least 1 shock. Patients receiving no therapy and those receiving only ATP had a lower cumulative hospitalization rate and were at lower risk for death or hospitalization (hazard ratio: 0.33 [p < 0.001] and 0.33 [p < 0.002], respectively). The cost of hospitalization was $2,874 per patient-year (95% confidence interval: $877 to $5,140; p = 0.002) higher for those receiving at least 1 shock than for those who received ATP only. There was no difference in outcomes or cost between patients receiving only ATP and those without therapy.
Conclusions:
Among patients implanted with an ICD for primary prevention, those who received only ATP therapy had reduced hospitalizations, mortality, and cost compared with those who received at least 1 high-voltage shock and had equivalent outcomes to patients who did not require any therapy. (Programming Implantable Cardioverter Defibrillators in Patients With Primary Prevention Indication [PROVIDE]; NCT00743522).
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