Cleveland Clinic Foundation, Cleveland Ohio.
Thomas Jefferson University, Philadelphia, Pennsylvania.
Heart Rhythm. 2017 Sep;14(9):1382-1387. doi: 10.1016/j.hrthm.2017.03.040. Epub 2017 Apr 4.
Implantable cardioverter-defibrillators (ICDs) are effective in terminating lethal arrhythmias, but little is known about the degree of health care utilization (HCU) after ICD therapies.
Using data from the managed ventricular pacing trial, we sought to identify the incidence and types of HCU in ICD patients after receiving ICD therapy (shocks or antitachycardia pacing [ATP]).
We analyzed HCU events (ventricular tachyarrhythmia [VTA]-related, heart failure-related, ICD implant procedure-related, ICD system-related, or other) and their association with ICD therapies (shocked ventricular tachycardia episode, ATP-terminated ventricular tachycardia episode, and inappropriately shocked episode).
A total of 1879 HCUs occurred in 695 of 1030 subjects (80% primary prevention) and were classified as follows: 133 (7%) VTA-related, 373 (20%) heart failure-related, 97 (5%) implant procedure-related, 115 (6%) system-related, and 1160 (62%) other. Of 2113 treated VTA episodes, 1680 (80%) received ATP only and 433 (20%) received shocks. Stratifying VTA-related HCUs on the basis of the type of ICD therapy delivered, there were 25 HCUs per 100 shocked VTA episodes compared with 1 HCU per 100 ATP-terminated episodes. Inappropriate ICD shocks occurred in 8.7% of the subjects and were associated with 115 HCUs. The majority of HCUs (52%) began in the emergency department, and 66% of all HCUs resulted in hospitalization.
For VTA-related HCUs, shocks are associated with a 25-fold increase in HCUs compared to VTAs treated by ATP only. Application of evidence-based strategies and automated device-based algorithms to reduce ICD shocks (higher rate cutoffs, use of ATP, and arrhythmia detection) may help reduce HCUs.
植入式心脏复律除颤器（ICD）可有效终止致命性心律失常，但对于 ICD 治疗后医疗保健利用（HCU）的程度知之甚少。
本研究使用管理心室起搏试验的数据，旨在确定 ICD 治疗（电击或抗心动过速起搏[ATP]）后 ICD 患者的 HCU 发生率和类型。
我们分析了 HCU 事件（与室性心动过速[VTA]相关、与心力衰竭相关、与 ICD 植入程序相关、与 ICD 系统相关或其他）及其与 ICD 治疗（电击治疗的室性心动过速发作、ATP 终止的室性心动过速发作和不适当电击发作）的关联。
在 1030 名受试者中的 695 名（80%为一级预防）中发生了 1879 次 HCU，分类如下：133 次（7%）与 VTA 相关，373 次（20%）与心力衰竭相关，97 次（5%）与植入程序相关，115 次（6%）与系统相关，1160 次（62%）与其他相关。在 2113 次治疗的 VTA 发作中，1680 次（80%）仅接受 ATP 治疗，433 次（20%）接受电击治疗。根据所给予的 ICD 治疗类型对 VTA 相关 HCU 进行分层，与每 100 次 ATP 终止的 VTA 发作相比，电击治疗的 VTA 发作每 100 次有 25 次 HCU。8.7%的受试者发生不适当的 ICD 电击，与 115 次 HCU 相关。大多数 HCU（52%）始于急诊科，66%的所有 HCU 导致住院。
对于与 VTA 相关的 HCU，电击治疗与仅接受 ATP 治疗的 VTA 相比，HCU 增加了 25 倍。应用循证策略和基于设备的自动算法来减少 ICD 电击（更高的率截止值、使用 ATP 和心律失常检测）可能有助于减少 HCU。
