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Heart failure hospitalizations and costs in ICD/CRT-D recipients following replacement or upgrade: the DECODE
Valerio Zacà1, Maria Lucia Narducci2, Matteo Ziacchi3
1Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Viale Bracci, 14, Siena, 53100, Italy.
Insights
Heart failure hospitalizations (HFH) and mortality rates after implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) replacement/upgrade were low. Underlying cardiac disease drove HFH, mortality, and healthcare costs.
Area of Science:
- Cardiology
- Medical Devices
- Health Economics
Background:
- Implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) are crucial for managing heart failure and arrhythmias.
- Device replacement or upgrade is common, necessitating an understanding of associated risks and costs, particularly heart failure hospitalizations (HFH).
Purpose of the Study:
- To determine heart failure hospitalization (HFH) rates and associated costs within 12 months following ICD/CRT-D device replacement or upgrade.
- To identify predictors of HFH and mortality in patients undergoing device procedures.
Main Methods:
- Prospective, single-arm, multicenter cohort study (DECODE registry) of 983 patients undergoing ICD/CRT-D replacement or upgrade.
- Clinical and survival data were collected for 12 months post-procedure.
- HFH events and associated costs were recorded and analyzed using ICD-9-CM codes and diagnosis-related groups.
Main Results:
- The overall HFH event rate was 9.6% (70 patients), with a significantly higher rate observed after upgrades from ICD to CRT-D.
- Mortality occurred in 6.7% of patients, with HFH associated with an 11-fold increased mortality risk (P < 0.0001).
- Predictors of HFH included atrial fibrillation, chronic kidney disease, and prior all-cause hospitalization within 30 days.
Conclusions:
- HFH and mortality rates were low in the year following ICD/CRT-D device replacement or upgrade.
- Underlying cardiac disease was identified as the primary driver of HFH, mortality, and healthcare expenditures in this cohort.
- The study highlights the importance of managing underlying cardiac conditions to mitigate risks and costs associated with device procedures.
Aims:
The aim of this study is to report heart failure hospitalization (HFH) rates and associated costs within 12 months following implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) device replacement or upgrade from ICD to CRT-D.
Methods And Results:
The DEtect long-term COmplications after icD rEplacement (DECODE) was a prospective, single-arm, multicentre cohort study that explored complications in ICD/CRT-D recipients. All clinical and survival data at 12 months were prospectively analysed. For each adjudicated HFH, admission and discharge dates and ICD-9-CM diagnosis and procedure codes were recorded. The reimbursement for each HFH was calculated for each diagnosis-related group code. Between 2013 and 2015, 983 patients (mean age 71 years, male 76%, mean left ventricular ejection fraction 35%, and New York Heart Association Class I/II 75.6%) were enrolled. Patients underwent device replacement (900; 91.6%, 446 ICD/454 CRT-D) or ICD upgrade to CRT-D (83; 8.4%). Post-replacement hospitalizations occurred in 220 patients, with the primary discharge diagnosis identifying cardiovascular causes in 175 patients (80%). Fifty-five (5.6%) patients experienced at least one HFH. Overall, 91 HFH events occurred (9.6% event rate, 95% confidence interval: 7.7-11.7) in 70 patients; 66 (6.7%) patients died, 40 (60.6%) of cardiovascular causes. The HFH rate was significantly higher following upgrades, and the occurrence of HFH was associated with an 11-fold increased mortality risk (95% confidence interval: 5.9-20.5, P < 0.0001). Medical diagnosis-related group accounted for 91.2% of HFH; the mean cost per HFH was €5662 ± 9497, and the mean cost per patient was €9369 ± 12 687. On multivariate analysis, predictors of HFH were atrial fibrillation, chronic kidney disease, and all-cause hospitalization within 30 days prior to the procedure.
Conclusions:
In the DECODE registry, HFH and mortality rates in the year following ICD/CRT-D replacement or upgrade were low. In this particular subset, underlying cardiac disease was the main driver of HFH, mortality, and higher healthcare expenditures.
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