Increased Hospitalizations and Overall?Healthcare Utilization in Patients?Receiving?Implantable Cardioverter-Defibrillator Shocks Compared With Antitachycardia Pacing

摘要

ObjectivesThe purpose of this study was to evaluate the effect of these therapies on healthcare utilization in a large patient cohort. BackgroundAntitachycardia pacing (ATP) terminates ventricular tachycardia and avoids delivery of high-voltage shocks. Few data exist on the impact of shocks on healthcare resource utilization compared with ATP. MethodsPROVIDE (Programming Implantable Cardioverter Defibrillators in Patients With Primary Prevention Indication) was a prospective study of patients who received an implantable cardioverter-defibrillator (ICD) for primary prevention at 97 U.S. centers (2008 to 2010). We categorized the PROVIDE patients by the type of therapy delivered:?no?therapy, ATP only, or at least 1 shock. All ICD therapies, hospitalizations, and deaths were adjudicated. Cumulative?cardiac hospitalizations, risk of all-cause death or cardiac hospitalization, and annual costs were compared?between groups. ResultsOf the 1,670 patients in PROVIDE, followed up for 18.1 ± 7.6 months, 1,316 received no therapy, 152 had ATP?only, and 202 received at least 1 shock. Patients receiving no therapy and those receiving only ATP had a lower?cumulative hospitalization rate and were at lower risk for death or hospitalization (hazard ratio: 0.33 [p?< 0.001] and 0.33 [p?< 0.002], respectively). The cost of hospitalization was $2,874 per patient-year (95% confidence interval:?$877 to $5,140; p?= 0.002) higher for those receiving at least 1 shock than for those who received ATP only. There was no difference in outcomes or cost between patients receiving only ATP and those without therapy. ConclusionsAmong patients implanted with an ICD for primary prevention, those who received only ATP therapy?had reduced hospitalizations, mortality, and cost compared with those who received at least 1 high-voltage shock?and?had equivalent outcomes to patients who did not require any therapy. (Programming Implantable Cardioverter?Defibrillators in Patients With Primary Prevention Indication [PROVIDE];NCT00743522).