Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Abbott, Chicago, Illinois.
JACC Clin Electrophysiol. 2018 Feb;4(2):243-253. doi: 10.1016/j.jacep.2017.09.004. Epub 2017 Nov 15.
The purpose of this study was to evaluate the effect of these therapies on healthcare utilization in a large patient cohort.
Antitachycardia pacing (ATP) terminates ventricular tachycardia and avoids delivery of high-voltage shocks. Few data exist on the impact of shocks on healthcare resource utilization compared with ATP.
PROVIDE (Programming Implantable Cardioverter Defibrillators in Patients With Primary Prevention Indication) was a prospective study of patients who received an implantable cardioverter-defibrillator (ICD) for primary prevention at 97 U.S. centers (2008 to 2010). We categorized the PROVIDE patients by the type of therapy delivered: no therapy, ATP only, or at least 1 shock. All ICD therapies, hospitalizations, and deaths were adjudicated. Cumulative cardiac hospitalizations, risk of all-cause death or cardiac hospitalization, and annual costs were compared between groups.
Of the 1,670 patients in PROVIDE, followed up for 18.1 ± 7.6 months, 1,316 received no therapy, 152 had ATP only, and 202 received at least 1 shock. Patients receiving no therapy and those receiving only ATP had a lower cumulative hospitalization rate and were at lower risk for death or hospitalization (hazard ratio: 0.33 [p < 0.001] and 0.33 [p < 0.002], respectively). The cost of hospitalization was $2,874 per patient-year (95% confidence interval: $877 to $5,140; p = 0.002) higher for those receiving at least 1 shock than for those who received ATP only. There was no difference in outcomes or cost between patients receiving only ATP and those without therapy.
Among patients implanted with an ICD for primary prevention, those who received only ATP therapy had reduced hospitalizations, mortality, and cost compared with those who received at least 1 high-voltage shock and had equivalent outcomes to patients who did not require any therapy. (Programming Implantable Cardioverter Defibrillators in Patients With Primary Prevention Indication [PROVIDE]; NCT00743522).
本研究旨在评估这些疗法在大型患者队列中对医疗保健利用的影响。
抗心动过速起搏（ATP）终止室性心动过速并避免高电压电击。与 ATP 相比，关于电击对医疗资源利用影响的数据很少。
PROVIDE（有原发性预防指征的植入式心脏复律除颤器编程）是一项在美国 97 个中心进行的前瞻性研究（2008 年至 2010 年），研究对象为接受植入式心脏复律除颤器（ICD）进行原发性预防的患者。我们根据所提供的治疗类型对 PROVIDE 患者进行分类：无治疗、仅 ATP 或至少 1 次电击。所有 ICD 治疗、住院和死亡均经裁决。比较各组之间的累计心脏住院率、全因死亡或心脏住院风险和年度费用。
在 PROVIDE 中，1670 例患者接受了 18.1±7.6 个月的随访，其中 1316 例未接受治疗，152 例仅接受 ATP，202 例至少接受 1 次电击。未接受治疗和仅接受 ATP 的患者的累计住院率较低，死亡或住院风险较低（风险比：0.33[<0.001]和 0.33[<0.002]）。至少接受 1 次电击的患者的住院费用为每位患者每年 2874 美元（95%置信区间：877 美元至 5140 美元；p=0.002）高于仅接受 ATP 的患者。仅接受 ATP 的患者与未接受治疗的患者在结局或成本方面没有差异。
在因原发性预防植入 ICD 的患者中，与至少接受 1 次高电压电击的患者相比，仅接受 ATP 治疗的患者的住院、死亡和成本降低，与无需任何治疗的患者的结局相当。（有原发性预防指征的植入式心脏复律除颤器编程[PROVIDE]；NCT00743522）。
