Valenti R, Schlåpfer J, Fromer M, Fischer A, Kappenberger L
Division of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Eur Heart J. 1996 Oct;17(10):1565-71. doi: 10.1093/oxfordjournals.eurheartj.a014722.
Patients who survive out-of-hospital ventricular tachycardia or ventricular fibrillation are at risk of sudden cardiac death and often return to hospital after initial discharge. The frequency and duration of readmittance to hospital are not well known. Thus, the purpose of this study was to evaluate the impact of the implantable cardioverter defibrillator on frequency and duration of hospitalizations.
Between 1989 and 1993, 38 consecutive patients who had drug-refractory ventricular tachyarrhythmias were selected for the study. A total of 38 patients were implanted with the implantable cardioverter-defibrillator in accordance with the guidelines of the European Society of Cardiology. This analysis includes 35 of the 38 patients (92%). All hospitalizations which occurred one year before and one year after were studied. Clinical information for all patients was obtained by consulting medical records and by interviewing personal general practitioners.
The annual number of hospitalizations before and after implantation of the implantable cardioverter-defibrillator was, respectively, 3.28 +/- 2.38 hospitalizations/ patient/year and 0.88 +/- 1.23 hospitalizations/patient/year (P < 0.05). Before implantation of the implantable cardioverter-defibrillator, patients were hospitalized a mean of 32.94 +/- 24.18 days/patient/year and after, 9.31 +/- 32.14 days/patient/year (P < 0.05). The number of hospitalizations for cardiac reasons decreased by 90%. Before implantation, the most frequent cause was ventricular tachyarrhythmia (47 hospitalizations for ventricular tachycardia and eight for ventricular fibrillation), while after implantation, it was as a result of the shock from the implantable cardioverter-defibrillator (11 hospitalizations). The number of hospitalizations for non-cardiac reasons were similar in the two time periods. Of the 35 patients, 26 (74%) had at least one appropriate successful ventricular tachycardia interrupted by the implantable cardioverter-defibrillator, while 17 patients (49%) had their ventricular fibrillation terminated. There is a significant difference in the rate of hospitalizations to intensive care units (ICU) between the two periods. Before implantation, 30% of hospital days were spent in the ICU, with 3% after.
This study documents that the implantable cardioverter-defibrillator not only reduces the frequency and duration of hospital stays, but reduces admissions to the more expensive units in hospital. Taking into account the reduction in hospitalizations, the payback period for the implantation of an implantable cardioverter-defibrillator is 19 months.
院外室性心动过速或心室颤动幸存者有心脏性猝死风险，且初次出院后常再次入院。再次入院的频率和时长尚不明确。因此，本研究旨在评估植入式心脏复律除颤器对住院频率和时长的影响。
1989年至1993年，连续选取38例药物难治性室性心律失常患者进行研究。按照欧洲心脏病学会指南，共38例患者植入了植入式心脏复律除颤器。本分析纳入了38例患者中的35例（92%）。研究了植入前一年和植入后一年发生的所有住院情况。通过查阅病历和采访个人全科医生获取所有患者的临床信息。
植入植入式心脏复律除颤器前后每年的住院次数分别为3.28±2.38次/患者/年和0.88±1.23次/患者/年（P<0.05）。植入植入式心脏复律除颤器前，患者平均住院时间为32.94±24.18天/患者/年，植入后为9.31±32.14天/患者/年（P<0.05）。因心脏原因住院的次数减少了90%。植入前，最常见的原因是室性心律失常（室性心动过速住院47次，心室颤动住院8次），而植入后，是由于植入式心脏复律除颤器的电击（住院11次）。两个时间段非心脏原因的住院次数相似。35例患者中，26例（74%）至少有一次适当的成功室性心动过速被植入式心脏复律除颤器中断，17例患者（49%）的心室颤动被终止。两个时期入住重症监护病房（ICU）的住院率有显著差异。植入前，30%的住院天数在ICU度过，植入后为3%。
本研究表明，植入式心脏复律除颤器不仅降低了住院频率和时长，还减少了入住医院费用更高科室。考虑到住院次数的减少，植入植入式心脏复律除颤器的投资回收期为19个月。
