Abstract 11117: Outcomes Among Medicare Beneficiaries are Optimized When Primary ICD Implant Occurs During an Elective Rather Than Unplanned Hospitalization
Introduction: Primary prevention implantable defibrillators (ICDs) are designed for elective implant in stable HF patients, although in real-world practice ICDs are often placed during an acute, unplanned hospitalization for heart failure or other comorbid conditions. We assessed if safety and long-term outcomes differ by reason for admission surrounding implant.
Methods: Using linked data from the National Cardiovascular Data Registry (NCDR®) ICD Registry™ and Medicare from 2005-2009, we identified patients ≥66years old and ejection fraction ≤ 35% who were electively hospitalized for ICD implant or those implanted during an acute, unplanned hospitalization. Risks of device complication, rehospitalization, and death were analyzed using Kaplan-Meier estimates and Cox regression.
Results: Among ICD recipients (n=68,004) with median age of 76 years, 23% had a HF hospitalization within the previous year and 51% had cardiac resynchronization therapy co-implanted. There was a high prevalence of diabetes (50%), chronic kidney disease (37%), and atrial fibrillation (51%). Patients receiving an ICD during an unplanned hospitalization (38%) had a greater burden of cardiac and non-cardiac co-morbidities, along with more severe HF, compared to patients electively hospitalized. Recipients during an unplanned hospitalization had a higher adjusted risk of implant-related complications (HR1.44. 95%CI 1.35-1.54), cardiac re-hospitalization (HR 1.65, 95%CI 1.61-1.69), and death (HR1.89, 95%CI 1.83-1.94). [Figure ]
Conclusion: More than 1/3 of primary ICDs were placed during a hospitalization intended to treat another illness, not primarily intended for ICD implant. Medicare beneficiaries receiving ICDs during unplanned hospitalization had more complications and worse outcomes. For eligible patients identified during unplanned hospitalization, it is not yet known whether ICD implant should be deferred until outpatient stability can be demonstrated.
- © 2013 by American Heart Association, Inc.