Healthcare After Implantable Cardioverter-Defibrillator Shocks
Underuse and Overuse
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Implantable cardioverter-defibrillators (ICDs) have become an important therapy for both primary and secondary prevention of sudden cardiac death among a large number of patients at high risk. ICD shocks are life saving when appropriate for ventricular arrhythmias. However, both appropriate and inappropriate shocks are associated with morbidity, including anxiety, depression, and impaired quality of life, as well as increased mortality.1,2 Thus, after receipt of a shock, it is logical that patients should be evaluated to determine the appropriateness of shock, the patient’s clinical condition, and whether any programming changes should be made to the device. However, best practices are not well defined. The extent to which patients are evaluated, in what setting, and what other testing or procedures are performed after ICD shock has not previously been defined.
See Article by Turakhia et al
In this issue of Circulation: Cardiovascular Quality and Outcomes, Turakhia et al3 present data on health care received after shock and the associated expenditures in a real-world population. Patients undergoing de novo ICD implantation between 2008 and 2010 were identified in a manufacturer database that includes information on device implant and remote monitoring. A deterministic matching algorithm was then used to link to commercial and Medicare supplemental claims databases to determine healthcare utilization. Patients were followed up through 2011 for shocks. All shock episodes were adjudicated to determine whether they were appropriate (ventricular tachycardia/ventricular fibrillation) or inappropriate (eg, supraventricular tachycardia, atrial fibrillation, or lead noise). Among all patients with linked outcomes data, 9% …