Mortality and Costs Associated with Wearable Cardioverter-defibrillators after Acute Myocardial Infarction: A...

Ventricular arrhythmias are common in the early period after myocardial infarction (MI), with the highest risk occurring in the immediate postinfarct window. The wearable cardioverter-defibrillator (WCD) has been proven to have efficacy in treating sudden cardiac arrest in patients soon after MI. However, data concerning clinical and health economic outcomes of WCD usage among Medicare patients have not been evaluated. The aim of this study was therefore to investigate the clinical and health economic impacts of WCD use among Medicare patients hospitalized for MI. A 5% sample of Medicare's Standard Analytical Files (2010-2012) was used to identify patients. Beneficiaries with an acute inpatient admission for acute MI were stratified by WCD presence and absence, respectively. Baseline clinical history, all-cause mortality, and the total cost of health-care expenditures over one year were collected. In total, 16,935 patients were included in the final analysis; of these, 89 were placed in the WCD group and 16,846 were placed in the non-WCD group. Overall, WCD patients were younger (70 versus 74 years of age; p < 0.001), more likely to be male (74.2% versus 57.4%; p = 0.002), and more likely to have congestive heart failure and/or ventricular arrhythmias prior to the indexed acute MI. At 30 days, the mortality rate in the WCD group (not reported due to volume < 11 Medicare beneficiaries) was lower in comparison with the non-WCD group (10.4%; p = 0.18). At one year, the adjusted mortality rates were 11.5% for the WCD group and 19.8% for the non-WCD group (hazard ratio: 0.46; p = 0.017). For the WCD group, the one-year incremental cost-effectiveness ratio was $12,373 per life-year gained. Among Medicare beneficiaries, WCD use after an acute MI was associated with better 30-day and one-year survival. Thus, our findings indicate that WCD use was cost-effective in the present sample of Medicare patients.