CLINICAL RESEARCH: HEART RHYTHM DISORDER
The Frequency and Incremental Cost of Major Complications Among Medicare Beneficiaries Receiving Implantable Cardioverter-Defibrillators
Matthew R. Reynolds, MD, MSc*,*,
David J. Cohen, MD, MSc*,
Aaron D. Kugelmass, MD ,
Phillip P. Brown, MD ,
Edmund R. Becker, PhD ,
Steven D. Culler, PhD and
April W. Simon, MSN||
* Beth Israel Deaconess Medical Center, Boston, Massachusetts
Henry Ford Hospital, Detroit, Michigan
Centennial Medical Center, Nashville, Tennessee
Emory University, Atlanta, Georgia
|| Cardiac Data Solutions, Atlanta, Georgia.
Manuscript received October 18, 2005;
revised manuscript received February 8, 2006,
accepted February 14, 2006.
* Reprint requests and correspondence: Dr. Matthew R. Reynolds, Division of Cardiology, Baker 4, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, Massachusetts 02215. (Email: mreynold{at}bidmc.harvard.edu).
OBJECTIVES: We aimed to quantify the frequency and nature of early complications after implantable cardioverter-defibrillator (ICD) implantation in general practice, and estimate the incremental costs of those complications to the health care system.
BACKGROUND: Cardioverter-defibrillator implantation rates are rising quickly. Little has been published regarding the outcomes and costs of these procedures in unselected populations.
METHODS: Using Medicare Provider Analysis and Review (MedPAR) files, we identified 30,984 admissions containing procedure codes for new ICD or cardiac resynchronization therapy defibrillator implantation in fiscal year 2003. The frequencies of eight complicating diagnoses during these admissions were determined. Length of stay (LOS) and total hospital costs, derived using whole-hospital cost to charge ratios, were calculated for each admission. The incremental effects of any and each complication on LOS and hospital cost were estimated in multivariable models, adjusting for demographic factors and comorbid conditions.
RESULTS: The mean cost for all admissions was $42,184 (median $37,902) with mean LOS of 4.7 days (median 2.0 days). One or more complications were coded in 10.8% of admissions, most commonly "mechanical complication of the ICD" and hemorrhage/hematoma. The occurrence of any complication increased adjusted LOS by 3.4 days and costs by $7,251. Each of the individual complications was associated with highly significant increases in both LOS (1 to 10 days) and hospital cost ($5,000 to $20,000).
CONCLUSIONS: In fiscal 2003, 10.8% of Medicare patients undergoing cardioverter-defibrillator implantation experienced one or more early complications, associated with significant increases in LOS and costs. Efforts to reduce these complications could have significant clinical and financial benefits.
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Abbreviations and Acronyms
| | CMS = Centers for Medicare and Medicaid Services | | CRT-D = cardiac resynchronization therapy-defibrillator | | ICD = implantable cardioverter-defibrillator | | ICD-9-CM = International Classification of Diseases-9th revision-Clinical Modification | | LOS = length of stay | | MEDPAR = Medicare Provider Analysis and Review |
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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|
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|
|
|
|
|
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171(16):
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|
|
|
|
|
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549 - 556.
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
M. Landolina, M. Gasparini, M. Lunati, S. Iacopino, G. Boriani, C. Bonanno, A. Vado, A. Proclemer, A. Capucci, C. Zucchiatti, et al.
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|
|
|
|
|
|
|
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123(19):
2069 - 2076.
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|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
|
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12(12):
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|
|
|
|
|
|
|
J. D. Lenchus
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110(6):
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|
|
|
|
|
|
|
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Implantable Cardiac Device Procedures in Older Patients: Use and In-Hospital Outcomes
Arch Intern Med,
April 12, 2010;
170(7):
631 - 637.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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774 - 782.
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|
|
|
|
|
|
|
B. Nowak, B. Misselwitz, on behalf of the expert committee 'Pacemaker', Ins, A. Erdogan, R. Funck, W. Irnich, C.W. Israel, H.-G. Olbrich, H. Schmidt, J. Sperzel, et al.
Do gender differences exist in pacemaker implantation?--results of an obligatory external quality control program
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February 1, 2010;
12(2):
210 - 215.
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|
|
|
|
|
|
|
M. Brignole
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September 1, 2009;
11(9):
1129 - 1133.
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|
|
|
|
|
|
|
R. J. Myerburg, V. Reddy, and A. Castellanos
Indications for Implantable Cardioverter-Defibrillators Based on Evidence and Judgment
J. Am. Coll. Cardiol.,
August 25, 2009;
54(9):
747 - 763.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Curtis, J. J. Luebbert, Y. Wang, S. S. Rathore, J. Chen, P. A. Heidenreich, S. C. Hammill, R. I. Lampert, and H. M. Krumholz
Association of Physician Certification and Outcomes Among Patients Receiving an Implantable Cardioverter-Defibrillator
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April 22, 2009;
301(16):
1661 - 1670.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. P. Anderson
Estimates of Implantable Cardioverter-Defibrillator Complications: Caveat Emptor
Circulation,
March 3, 2009;
119(8):
1069 - 1071.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. N. Peterson, S. L. Daugherty, Y. Wang, H. J. Vidaillet, P. A. Heidenreich, J. P. Curtis, F. A. Masoudi, and on behalf of the National Cardiovascular Data Regi
Gender Differences in Procedure-Related Adverse Events in Patients Receiving Implantable Cardioverter-Defibrillator Therapy
Circulation,
March 3, 2009;
119(8):
1078 - 1084.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Kelley, S. S. Mehta, and M. Carrington Reid
Management of Patients with ICDs at the End of Life (EOL): A Qualitative Study
American Journal of Hospice and Palliative Medicine,
January 1, 2009;
25(6):
440 - 446.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. Tung, P. Zimetbaum, and M. E. Josephson
A Critical Appraisal of Implantable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death
J. Am. Coll. Cardiol.,
September 30, 2008;
52(14):
1111 - 1121.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. W. Chapa, H.-J. Lee, C.-W. Kao, E. Friedmann, S. A. Thomas, J. Anderson, and G. H. Bardy
Reducing Mortality With Device Therapy in Heart Failure Patients Without Ventricular Arrhythmias
Am. J. Crit. Care.,
September 1, 2008;
17(5):
443 - 452.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Al-Khatib, M. A. Greiner, E. D. Peterson, A. F. Hernandez, K. A. Schulman, and L. H. Curtis
Patient and Implanting Physician Factors Associated With Mortality and Complications Following Implantable Cardioverter-Defibrillator Implantation, 2002-2005: Al-Khatib - Patient and Physician Factors and ICD Outcomes.
Circ Arrhythm Electrophysiol,
January 1, 2008;
1(4):
240 - 249.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A McAlister
Device therapy in heart failure
BMJ,
November 3, 2007;
335(7626):
895 - 896.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Almendral and M. E. Josephson
All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator
Circulation,
September 4, 2007;
116(10):
1204 - 1212.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Ezekowitz, B. H. Rowe, D. M. Dryden, N. Hooton, B. Vandermeer, C. Spooner, and F. A. McAlister
Systematic Review: Implantable Cardioverter Defibrillators for Adults with Left Ventricular Systolic Dysfunction
Ann Intern Med,
August 21, 2007;
147(4):
251 - 262.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Jahangir, D. J. Bradley, and W. K. Shen
ICDs for secondary prevention of sudden death in the older-elderly
Eur. Heart J.,
July 2, 2007;
28(14):
1665 - 1667.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A. McAlister, J. Ezekowitz, N. Hooton, B. Vandermeer, C. Spooner, D. M. Dryden, R. L. Page, M. A. Hlatky, and B. H. Rowe
Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction: A Systematic Review
JAMA,
June 13, 2007;
297(22):
2502 - 2514.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. J. Zimetbaum
A 59-Year-Old Man Considering Implantation of a Cardiac Defibrillator
JAMA,
May 2, 2007;
297(17):
1909 - 1916.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. S. Chan, T. Chow, D. Kereiakes, E. J. Schloss, T. Waller, K. Eagle, R. A. Hayward, and S. Vijan
Effectiveness of implantable cardioverter-defibrillators in patients with ischemic heart disease and left ventricular dysfunction.
Arch Intern Med,
November 13, 2006;
166(20):
2228 - 2233.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
