Introduction:
Few studies have characterized the cost of health care associated with implantable cardioverter defibrillator (ICD) shocks. The objective of this study was to understand healthcare utilization patterns and expenditures following an ICD or cardiac resynchronization therapy defibrillator (CRT-D) shock.
Methods:
Using Medtronic’s Data Warehousing & Analytics Services (DWAS) database patients with an ICD or CRT-D implant date between 2008 and 2010 were identified. Implant records from DWAS were matched to patient level data in MarketScan® Commercial and Medicare claims databases (Truven Health Analytics, Inc) based on date and type of implant, gender, age, patient three digit zip code and location of care. A shock event was defined as a date where one or more spontaneous shocks (appropriate or inappropriate) were delivered. Shock events were recorded in DWAS and used to identify shock-related healthcare utilization in MarketScan. Shock-related healthcare utilization was defined as a visit with a diagnosis (primary diagnosis for inpatient) of dysrhythmia, syncope/dizziness, device malfunction, palpitations or tachycardia beginning within 7 days following a shock event. Shock events occurring during an ongoing inpatient stay were excluded. Expenditures for all shock-related utilization following a shock event were tallied and summarized.
Results:
Of 7705 patients matched between the 2 databases, 773 patients had 1409 shock events and 58 were excluded due to ongoing inpatient stay. Of the 1351 remaining shock days 798 (59%) were followed by any healthcare utilization and 575 (43%) were followed by shock-related healthcare utilization. The majority of patients (65%) seeking shock-related care did so on the same day as the shock. 157 shock events (11.6%) were followed by an inpatient stay and had a mean length of stay of 3.6±3.0 days. There was wide variation in shock-related expenditures (mean $5,124±$11,992; median $1,131) and expenditures were similar between ICD and CRT-D patients. Expenditures were higher when shock events were followed by inpatient care ($15,167±$19,229, median $8,812), as compared outpatient care only ($1,352±$2,716, median $376).
Conclusion:
Nearly 1 in 8 shock events were followed by hospitalization. Expenditures were higher when inpatient care followed a shock event as compared to when all care occurred in the outpatient setting. Strategies to reduce the incidence of ICD shocks may result in significant healthcare savings.
Termination of arrhythmias by anti-tachycardia pacing is associated with very low healthcare utilization compared to shock therapy in patients with an implantable cardioverter defibrillator
