Healthcare Utilization and Expenditures Associated With Appropriate and Inappropriate Implantable Defibrillator Shocks.
BACKGROUND
In patients with implantable cardioverter-defibrillators, healthcare utilization (HCU) and expenditures related to shocks have not been quantified.


METHODS AND RESULTS
We performed a retrospective cohort study of patients with implantable cardioverter-defibrillators identified from commercial and Medicare supplemental claims databases linked to adjudicated shock events from remote monitoring data. A shock event was defined as ≥1 spontaneous shocks delivered by an implanted device. Shock-related HCU was ascertained from inpatient and outpatient claims within 7 days following a shock event. Shock events were adjudicated and classified as inappropriate or appropriate, and HCU and expenditures, stratified by shock type, were quantified. Of 10 266 linked patients, 963 (9.4%) patients (61.3±13.6 years; 81% male) had 1885 shock events (56% appropriate, 38% inappropriate, and 6% indeterminate). Of these events, 867 (46%) had shock-related HCU (14% inpatient and 32% outpatient). After shocks, inpatient cardiovascular procedures were common, including echocardiography (59%), electrophysiology study or ablation (34%), stress testing (16%), and lead revision (11%). Cardiac catheterization was common (71% and 51%), but percutaneous coronary intervention was low (6.5% and 5.0%) after appropriate and inappropriate shocks. Expenditures related to appropriate and inappropriate shocks were not significantly different.


CONCLUSIONS
After implantable cardioverter-defibrillator shock, related HCU was common, with 1 in 3 shock events followed by outpatient HCU and 1 in 7 followed by hospitalization. Use of invasive cardiovascular procedures was substantial, even after inappropriate shocks, which comprised 38% of all shocks. Implantable cardioverter-defibrillator shocks seem to trigger a cascade of health care. Strategies to reduce shocks could result in cost savings.
['Turakhia|Mintu P|MP|', 'Zweibel|Steven|S|', 'Swain|Andrea L|AL|', 'Mollenkopf|Sarah A|SA|', 'Reynolds|Matthew R|MR|']
D000067575:Administrative Claims, Healthcare D000368:Aged D000553:Ambulatory Care D001145:Arrhythmias, Cardiac D016208:Databases, Factual D017147:Defibrillators, Implantable D004554:Electric Countershock D004868:Equipment Failure D005260:Female D017048:Health Care Costs D005102:Health Expenditures D006295:Health Resources D017721:Hospital Costs D006801:Humans D008297:Male D016345:Medicare Part B D008875:Middle Aged D010343:Patient Admission D017064:Process Assessment, Health Care D012189:Retrospective Studies D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D014481:United States D019564:Unnecessary Procedures
defibrillators electrophysiology hospitalization cardiac arrhythmias