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Utilization of Implantable Cardioverter-Defibrillators in Patients With Heart Transplant (from National Inpatient
Abdul Mannan Khan Minhas1, Sayed Mustafa Mahmood Shah2, Izza Shahid3
1Division of Medicine, Forrest General Hospital, Hattiesburg, Mississippi.
Insights
Implantable cardioverter-defibrillator (ICD) placement in heart transplant (HT) recipients is uncommon and linked to higher costs. Cardiac arrest, drug abuse, and prior PCI predict ICD use in these patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Heart transplant (HT) recipients face risks of arrhythmias and sudden cardiac death.
- The role of implantable cardioverter-defibrillators (ICDs) in HT patients is debated.
- Optimal management strategies for arrhythmia prevention in HT survivors require further investigation.
Purpose of the Study:
- To analyze trends and predictors of ICD placement in heart transplant recipients.
- To assess the impact of ICD placement on healthcare costs in this population.
- To identify factors associated with ICD utilization in patients with a history of heart transplantation.
Main Methods:
- Retrospective analysis of National Inpatient Sample data (2009-2018).
- Inclusion of hospitalizations for heart transplant recipients receiving a new ICD.
- Assessment of inpatient mortality, length of stay, and inflation-adjusted costs.
Main Results:
- ICD placement occurred in only 0.31% of concurrent HT hospitalizations.
- ICD placement in patients with a history of HT was associated with significantly higher costs ($55,680.7 vs $17,219.2).
- Predictors for ICD placement in HT patients included in-hospital cardiac arrest, drug abuse, and prior percutaneous coronary intervention (PCI).
Conclusions:
- ICD placement in heart transplant recipients is infrequent and significantly increases healthcare costs.
- Cardiac arrest during hospitalization, prior PCI, and drug abuse are key predictors for ICD implantation in patients with a history of HT.
- Further research is needed to refine guidelines for ICD use in this unique patient cohort.
Abstract:
Heart transplant (HT) recipients represent a unique and vulnerable population in whom medium and long-term outcomes are significantly affected by the risk of arrhythmias and sudden cardiac death. The use of implantable cardioverter-defibrillators (ICDs) in this population remains debated. A retrospective analysis of the National Inpatient Sample data between 2009 and 2018 was conducted. Hospitalization data on patients who underwent HT, or who had a preexisting HT, and who received a new ICD were included (excluding the preexisting ICD). Outcomes assessed included inpatient mortality, length of stay, and inflation-adjusted costs. We explored temporal trends in ICD placement and mean length of stay, and predictors of ICD placement. Between 2009 and 2018, 22,673 hospitalizations were recorded for HT, during which patients either received a concurrent new ICD placement (n = 70 [0.31%]) or no new ICD placement (n = 22,603 [99.7%]). During the same period, 146,555 admissions were recorded in patients with a history of HT. ICD placement in patients with a preexisting HT was associated with significantly higher inflation-adjusted costs ($55,680.7 vs $17,219.2; p <0.001). Predictors of ICD placement in preexisting patients with HT included cardiac arrest during hospitalization (odds ratio [OR]:14.3 [3.5 to 58.6]), drug abuse (OR:6.0 [1.3 to 27.1]), and previous PCI (OR:6.0 [2.1 to 17.3]). In conclusion, ICD placement in patients with HT history was associated with significantly higher inflation-adjusted costs. In patients with HT history, factors predicting ICD placement included cardiac arrest at hospitalization, previous PCI, and drug abuse.
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