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ICD shocks increase health care costs
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In patients with implantable cardioverter defibrillators, shocks, whether appropriate or inappropriate, result in increased health care utilization and CV procedures, according to recent findings.
“There is limited information on health care utilization associated with ICD shocks and whether inappropriate and appropriate shocks have differences in type, intensity or cost of care,” Mintu P. Turakhia, MD, MAS, of Stanford University School of Medicine and Veterans Affairs Palo Alto Health Care System, and colleagues wrote. “Moreover, detailed knowledge of utilization following an appropriate vs. inappropriate shock may elucidate downstream patterns of care and potential mediators of the differences in patient survival after shocks.”
Turakhia and colleagues analyzed patients (n = 10,266) with ICDs implanted between 2008 and 2010. During follow-up, 9.4% of patients (n = 963; mean age, 61 years; 81% men) had 1,885 shock events; 56% were determined to be appropriate, 38% inappropriate and 6% indeterminate.
Of these events, 46% had shock-related health care utilization (14% inpatient and 32% outpatient).
CV procedures were common after shocks of both types, including echocardiography (59%), electrophysiology study or ablation (34%), stress testing (16%) and lead revision (11%). Cardiac catheterization was common after appropriate (71%) and inappropriate (51%) shocks; PCI was not (appropriate, 6.5%; inappropriate, 5%).
The average health care cost after shock was higher in appropriate shock ($5,592) vs. inappropriate shock ($4,470), but the difference was not significant.
“[Health care utilization] and expenditures, including use of [CV] procedures, were substantial even after inappropriate shock events. Strategies to reduce the incidence of ICD shocks may result in significant reductions in [health care utilization] and expenditures,” the researchers concluded. “Further investigation is warranted to determine the impact on survival of these procedures after appropriate and inappropriate shocks.” – by Cassie Homer
Disclosure: Turakhia reports consulting for Medtronic and St. Jude Medical and receiving speaking honoraria from St. Jude Medical. Please see the full study for the other researchers’ relevant financial disclosures.
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