Open AccessDeterminants of outcomes following outpatient placement of implantable cardioverter defibrillators in a Medicare Advantage population
Author(s) -
Rogstad Teresa L.,
Powell Adam C.,
Song Yongjia,
Cordier Tristan,
Price Stephen E.,
Long James W.,
Deshmukh Uday U.,
Simmons Jeffrey D.
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23041
Subject(s) - medicine , heart failure , hazard ratio , proportional hazards model , implantable cardioverter defibrillator , comorbidity , population , emergency department , emergency medicine , diabetes mellitus , confidence interval , environmental health , psychiatry , endocrinology
Background Recipients of ICD are likely to have several risk factors that could interfere with successful use of implantable cardioverter defibrillators (ICDs). Hypothesis Age, sex, and factors indicated in claims are associated with one‐year mortality and complications after ICD placement. Methods Adult Medicare Advantage patients who underwent outpatient ICD implantation from January 2014 to September 2015 were included. Age, sex, Charlson Comorbidity Index (CCI), prior year hospitalization and emergency department (ED) visit, diabetes, heart failure, ischemic heart disease, and indicators of the need for pacing were evaluated as risk factors. Mortality and device‐related complications (lead and nonlead) were assessed at one‐year post‐procedure using Kaplan‐Meier and Cox Proportional Hazard analysis. Results Among 8450 patients who underwent implantation, 1‐year event‐free survival was 80.1%, based on an overall composite measure of complications and mortality. Adjusted survival analysis showed that age ≥ 65, male sex, incremental increase in CCI, heart failure, prior year hospitalization, ED visit, and prior year pacing procedure were significant predictors of mortality. Age ≥ 65, male sex, and prior year hospitalization were significant predictors of a composite measure of device‐related complications. CCI and prior hospitalization were significant predictors of a composite measure of any adverse outcome. Conclusions Results suggest most patients in an older population do not experience adverse outcomes in the year following ICD implantation. The risk of mortality may be greater in men, patients over the age of 65, and patients with greater general morbidity, heart failure, or a history of a pacing procedure.