Copyright © 2000 by the European Society of Cardiology.
Hospital readmission after transvenous cardioverter/defibrillator implantation. A single centre study
a Departments of Cardiology, University of Bonn, Bonn, Germany
b Cardiovascular Surgery, University of Bonn, Bonn, Germany
revised November 22, 1999; accepted November 24, 1999
Abstract
Aims Hospital readmission after implantation of cardioverter/defibrillators has a major impact on quality of life and cost-effectiveness in defibrillator patients. Rehospitalization has not been studied in large patient populations with modern transvenous defibrillation systems.
Methods and Results We report on incidence, reasons, time in follow-up, duration and predictors of hospital readmission in 180 patients after transvenous implantation of a cardioverter/defibrillator during a follow-up period of 25±18 months. There were 156 readmissions in 79 patients with a 0·87 readmission rate per patient during the time followed, a 0·46 readmission rate per patient-year of follow-up and a 0·38 readmission rate per patient-year of follow-up for cardiac reasons. The majority of readmissions was caused by multiple appropriate shock interventions (26%), battery depletion (19%) and lead- and device-related complications (14%). The time to first hospital readmission was 12±9 months for arrhythmia-related and 20±16 months for other cardiac-related reasons (P<0·05), and could not be predicted by clinical variables, respectively. The duration of rehospitalization was 14±15 days for cardiac-related reasons and 12±17 days for arrhythmia-related reasons. Age >60 years was an independent predictor of rehospitalization time per patient-year of follow-up for both cardiac-related (P<0·005) and arrhythmia-related reasons (P<0·05).
Conclusion The rate of hospital readmission per patient-year of follow-up is as high as 0·46 after implantation of a modern cardioverter/defibrillator. Rehospitalization time in such patients is significantly longer in the patient cohort >60 years. The majority of readmissions is caused by multiple appropriate shock treatments. Further studies are needed to systematically investigate strategies for the prevention of rehospitalization in modern ICD therapy.
Key Words: Implantable cardioverter defibrillator, hospital readmission, rehospitalization time
f1 Correspondence: Thomas Korte, MD, Dept. of Cardiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
References
- Winkle RA, Mead RH, Ruder MA. Long-term outcome with the automatic implantable cardioverter-defibrillator. J Am Coll Cardiol. 1989;13:1353–1361[Abstract]
- Powell AC, Fuchs P, Finkelstein DM. Influence of the automatic implantable cardioverter-defibrillator on the long-term prognosis of survivors of out-of-hospital cardiac death. Circulation. 1993;88:1083–1092
[Abstract/Free Full Text] - Moss AJ, Hall WJ, Cannom DS. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med. 1996;335:1933–1940
[Abstract/Free Full Text] - Kolettis TM, Saksena S. Prophylactic implantable cardioverter-defibrillator therapy in high-risk patients with coronary artery disease. Am Heart J. 1994;124:1164–1170
- Roper WL, Winkenwerder W, Hackbarth GM, Krakauer MD. Effectiveness in health care: an initiative to evaluate and improve medical practice. N Engl J Med. 1988;319:1197–1202[ISI][Medline]
- Rosenqvist M, Beyer T, Block M, den Dulk K, Minten J, Lindemans F. Adverse events with transvenous implantable cardioverter-defibrillators: a prospective multicenter study. Circulation. 1998;98:663–670
[Abstract/Free Full Text] - Mushlin AI, Hall J, Zwanziger J. The cost-effectiveness of automatic implantable cardioverter defibrillators: results from MADIT. Circulation. 1998;97:2129–2135
[Abstract/Free Full Text] - Fahy GJ, Sarbossa EB, Daunch RN, Pinski S. The significance of hospital readmission in patients treated with contemporary implantable defibrillators. Circulation. 1996;94:1350–1356
[Abstract/Free Full Text] - N Engl J Med. 1997;337:1576–1583
[Abstract/Free Full Text] - Valenti R, Schlapfer J, Fromer M, Fischer A, Kappenberger L. Impact of the implantable cardioverter-defibrillator on rehospitalisation. Eur Heart J. 1996;17:1565–1571
[Abstract/Free Full Text] - Böcker D, Block M, Isbruch F. Comparison of frequency of aggravation of ventricular tachyarrhythmias after implantation of automatic defibrillators using epicardial versus nonthoracotomy lead systems. Am J Cardiol. 1993;71:1064–1068[CrossRef][ISI][Medline]
- Nunain SO, Roelke M, Trouton T. Limitations and late complications of third-generation automatic cardioverter-defibrillators. Circulation. 1995;91:2204–2213
[Abstract/Free Full Text] - Zipes DP, Roberts D. Results of the international study of the implantable pacemaker cardioverter-defibrillator. A comparison of epicardial and endocardial lead systems. Circulation. 1995;92:59–65
[Abstract/Free Full Text] - Swerdlow CD, Chen PS, Kass RM, Allard JR, Peter T. Discrimination of ventricular tachycardia from sinus tachycardia and atrial fibrillation in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol. 1994;23:1342–1355[Abstract]
- Korte T, Jung W, Wolpert C. A new classification algorithm for discrimination of ventricular from supraventricular tachycardia in a dual chamber implantable defibrillator. J Cardiovasc Electrophysiol. 1998;9:70–73[ISI][Medline]
- Strickberger SA, Man KC, Daoud EG. A prospective evaluation of catheter ablation of ventricular tachycardia as adjuvant therapy in patients with coronary artery disease and an implantable cardioverter-defibrillator. Circulation. 1997;96:1525–1531
[Abstract/Free Full Text] - Tebbenjohanns J, Pfeiffer D, Schumacher B, Jung W, Manz M, Lüderitz B. Slowing of the ventricular rate during atrial fibrillation by ablation of the slow pathway of AV nodal reentrant tachycardia. J Cardiovasc Electrophysiol. 1995;6:711–715[ISI][Medline]
- Schumacher B, Tebbenjohanns J, Jung W, Korte T, Pfeiffer D, Lüderitz B. Radiofrequency catheter ablation of atrial flutter that elicits inappropriate implantable cardioverter defibrillator discharges. PACE. 1997;20:125–127
- Korte T, Jung W, Spehl S. Incidence of ICD lead related complications during long-term follow-up: comparison of epicardial and endocardial electrode systems. PACE. 1995;18:2053–2061
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