Abstract 17202: Characterization and Financial Impact of Patients With Unused Implantable Cardioverter Defibrillator 5 Years After Implantation
Background: Implantable cardioverter-defibrillators (ICDs) are increasingly used for primary and secondary prevention of sudden cardiac death. However, a substantial fraction of ICD patients will never receive appropriate ICD therapy, and long-term follow-up data on ICD patients are rare. The aim of our study was to determine amount of and predictors for non-use as well as financial impact of patients with unused ICDs 5 years after implantation.
Methods: We prospectively enrolled 322 consecutive ICD patients. Baseline data were collected at device implantation and all patients were followed-up for 101±30 months (range 60–187 months) regarding first appropriate ICD-therapy, inappropriate shocks and device replacement.
Results: After 5 years of follow up, 139 patients (43%) were free of appropriate ICD therapy. Patients with unused ICD were younger (median 57 vs. 63 years, p<0.001), more often had indication for primary prevention (34% vs. 21%, p=0.01) and had higher baseline ejection fraction (35% vs. 30%, p=0.02). In multivariable analysis, age <60 years, negative electrophysiological studies prior to implantation and implantation after 1.1.2000 were independent predictors for non-use. Of the patients with unused ICD after 5 years, 35 (25%) had experienced at least one episode of inappropriate ICD shock. A total number of 207 devices (1.5 devices per patient) was needed for the 139 patients within 5 years, accounting for around 43'000 $ per patient.
Conclusions: Nearly half of ICD patients seen in daily practice do not have appropriate ICD therapy within 5 years after implantation, highlighting the medical and economic need for improved patient selection.
- © 2010 by American Heart Association, Inc.