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Long-interval ICD programming reduced hospitalizations, costs
A long-detection interval approach to programming for implantable cardioverter defibrillators, combined with antitachycardia pacing during charging, was associated with a longer time to first hospitalization compared with standard-detection interval programming, according to new results from the ADVANCE III trial.
Long-detection intervals also decreased the rate of hospitalization, length of hospital stay and per-patient annual costs.
The exploratory analysis of the ADVANCE III trial focused on 1,902 patients who were undergoing first-time ICD implantation at 94 centers from 2008 to 2010. Patients were randomly assigned to a long-detection interval group, in which the number of intervals to detect arrhythmias was programmed at 30 of 40 (n=948), or a standard-detection interval group, in which the number of intervals to detect arrhythmias was programmed at 18 of 24 (n=954). Antitachycardia pacing during capacitor charge was activated in both groups. Follow-up was conducted every 3 months for 1 year.
During follow-up, the researchers reported 865 hospitalizations involving 546 patients (473 hospitalizations of 302 patients in the standard-interval group; 392 hospitalizations of 244 patients in the long-interval group).
The long-interval group had a significantly longer time to first overall hospitalization compared with the standard-interval group (HR=0.81; 95% CI, 0.68-0.95) and a longer time to first CV-related hospitalization (HR=0.81; 95% CI, 0.67-0.98). Long intervals were also associated with a lower overall hospitalization rate per 100 patient-years (43.8 vs. 52.3; IRR=0.85; 95% CI, 0.73-0.96) and shorter hospital stay per 100 patient-years (407 vs. 470; IRR=0.87; 95% CI, 0.83-0.91).
Mortality rates did not differ between the two groups.
Compared with standard-intervals, the long-interval group had a $299 mean reduction per patient-year in costs for overall hospitalizations and a $329 mean reduction per patient-year in costs for CV-related hospitalizations.
“The reduction in all-cause hospitalizations was mainly driven by the reduction in CV hospitalizations,” the researchers wrote. “… These favorable results for resource use complement the demonstrated clinical effectiveness of the long-detection interval strategy and come without additional costs for the hospitals or patients.”
Disclosure: The ADVANCE III study was supported by Medtronic.