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Hospital readmission in patients treated with tiered-therapy implantable defibrillators
G J Fahy1, E B Sgarbossa, P J Tchou
1Department of Cardiology, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Cardiac-related hospital readmissions are common in patients with implantable defibrillators, leading to significant costs. Arrhythmia-related readmissions cannot be predicted by pre-implantation clinical factors.
Area of Science:
- Cardiology
- Medical Device Technology
- Health Economics
Background:
- Hospital readmission negatively impacts quality of life for patients with implantable defibrillators.
- Readmissions associated with defibrillator therapy incur significant healthcare costs.
Purpose of the Study:
- To determine the incidence, reasons, costs, and predictors of cardiac-related hospital readmission.
- To analyze readmission patterns in patients with tiered-therapy implantable defibrillators.
Main Methods:
- Retrospective study of 65 patients undergoing tiered-therapy defibrillator implantation.
- Analysis of cardiac admissions, duration, costs, and predictors over a median follow-up of 19 months.
Main Results:
- The rate of cardiac-related hospital readmission was 0.72 per patient-year.
- Arrhythmia-related admissions occurred in 24 patients (43 admissions).
- Poor pre-implantation New York Heart Association functional class predicted time to readmission and rehospitalization duration.
Conclusions:
- Cardiac rehospitalization is frequent in implantable defibrillator patients, consuming substantial resources.
- Clinical parameters at implantation do not predict the need for readmission due to cardiac arrhythmias.
Background:
We wished to determine the incidence, reasons, costs, and predictors of cardiac-related hospital readmission in patients with tiered-therapy implantable defibrillators. Hospital readmission in patients with defibrillators reduces their quality of life and increases the cost associated with such therapy.
Methods And Results:
We retrospectively studied 65 consecutive local patients (median age, 67 years; median ejection fraction, 0.34) who underwent tiered-therapy defibrillator implantation at this institution. Patients were followed for a median of 19 months (interquartile range, 10 to 27 months). The cause, duration, costs, and predictors of cardiac-related rehospitalizations were analyzed. There were 76 cardiac admissions for 34 patients. The rate of cardiac-related hospital readmission was 0.72 per patient-year of follow-up. Arrhythmia-related admissions accounted for 43 of such admissions in 24 patients. Actuarial freedom from cardiac-related admissions was 0.57 and 0.40 at 1 and 2 years, respectively. The median length of stay for hospital readmissions was 5 days (interquartile range, 3 to 8 days). The median cost per admission was $5842 (interquartile range, $3549 to $12 170). The time to first readmission and the total rehospitalization time per year of follow-up were associated with a poor preimplant New York Heart Association functional class. Readmission for cardiac arrhythmias was not predicted by clinical parameters.
Conclusions:
Rehospitalization for cardiac reasons is common in patients receiving implantable defibrillators and is responsible for substantial resource consumption. The need for readmission for arrhythmia-related reasons cannot be predicted by clinical parameters at the time of device implantation.