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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
Impact of the implantable cardioverter-defibrillator on rehospitalizations
R Valenti1, J Schlåpfer, M Fromer
1Division of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Insights
The implantable cardioverter-defibrillator significantly reduces hospitalizations for patients with ventricular tachycardia or fibrillation. This device lowers both the frequency and duration of hospital stays, improving patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Patients surviving out-of-hospital ventricular tachycardia (VT) or ventricular fibrillation (VF) face recurrent risks and frequent hospital readmissions.
- The impact of implantable cardioverter-defibrillators (ICDs) on hospitalization frequency and duration in these patients is not well-established.
Purpose of the Study:
- To evaluate the effect of ICD implantation on the frequency and duration of hospitalizations in patients with drug-refractory ventricular tachyarrhythmias.
Main Methods:
- A cohort of 35 patients (out of 38 initially selected) with drug-refractory ventricular tachyarrhythmias received ICDs between 1989 and 1993.
- Hospitalizations were analyzed for one year prior to and one year after ICD implantation, with data collected from medical records and general practitioners.
Main Results:
- ICD implantation significantly reduced annual hospitalizations from 3.28 to 0.88 per patient (P < 0.05) and hospitalization duration from 32.94 to 9.31 days per patient (P < 0.05).
- Cardiac-related hospitalizations decreased by 90%, with VT/VF being the primary cause pre-ICD and ICD shocks post-ICD.
- ICD therapy successfully terminated VT in 74% of patients and VF in 49%, with a significant reduction in intensive care unit (ICU) hospital days from 30% to 3%.
Conclusions:
- Implantable cardioverter-defibrillators effectively reduce the frequency and duration of hospitalizations in at-risk patients.
- The device also decreases admissions to costly intensive care units, with an estimated 19-month payback period based on hospitalization cost reduction.
Unlabelled:
Patients who survive out-of-hospital ventricular tachycardia or ventricular fibrillation are at risk of sudden cardiac death and often return to hospital after initial discharge. The frequency and duration of readmittance to hospital are not well known. Thus, the purpose of this study was to evaluate the impact of the implantable cardioverter defibrillator on frequency and duration of hospitalizations.
Methods:
Between 1989 and 1993, 38 consecutive patients who had drug-refractory ventricular tachyarrhythmias were selected for the study. A total of 38 patients were implanted with the implantable cardioverter-defibrillator in accordance with the guidelines of the European Society of Cardiology. This analysis includes 35 of the 38 patients (92%). All hospitalizations which occurred one year before and one year after were studied. Clinical information for all patients was obtained by consulting medical records and by interviewing personal general practitioners.
Results:
The annual number of hospitalizations before and after implantation of the implantable cardioverter-defibrillator was, respectively, 3.28 +/- 2.38 hospitalizations/ patient/year and 0.88 +/- 1.23 hospitalizations/patient/year (P < 0.05). Before implantation of the implantable cardioverter-defibrillator, patients were hospitalized a mean of 32.94 +/- 24.18 days/patient/year and after, 9.31 +/- 32.14 days/patient/year (P < 0.05). The number of hospitalizations for cardiac reasons decreased by 90%. Before implantation, the most frequent cause was ventricular tachyarrhythmia (47 hospitalizations for ventricular tachycardia and eight for ventricular fibrillation), while after implantation, it was as a result of the shock from the implantable cardioverter-defibrillator (11 hospitalizations). The number of hospitalizations for non-cardiac reasons were similar in the two time periods. Of the 35 patients, 26 (74%) had at least one appropriate successful ventricular tachycardia interrupted by the implantable cardioverter-defibrillator, while 17 patients (49%) had their ventricular fibrillation terminated. There is a significant difference in the rate of hospitalizations to intensive care units (ICU) between the two periods. Before implantation, 30% of hospital days were spent in the ICU, with 3% after.
Conclusions:
This study documents that the implantable cardioverter-defibrillator not only reduces the frequency and duration of hospital stays, but reduces admissions to the more expensive units in hospital. Taking into account the reduction in hospitalizations, the payback period for the implantation of an implantable cardioverter-defibrillator is 19 months.
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