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Journal of Interventional Cardiac Electrophysiology

Published in:

01-10-2017

Reasons for and predictors of acute hospitalization versus elective outpatient implantable cardioverter-defibrillator implantation and subsequent differential clinical outcomes

Authors: Marin Nishimura, Shiv Sab, Ulrika Birgersdotter-Green, David Krummen, Amir Schricker, Farshad Raissi, Kurt S. Hoffmayer, Gregory K. Feld, Jonathan C. Hsu

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2017

Abstract

Background

Implantable cardioverter-defibrillator (ICD) implantation is often an elective outpatient procedure, but previous studies have shown that approximately 30% are performed during acute hospitalizations.

Purpose

This study aims to identify predictors of acute hospitalization versus elective outpatient ICD implantation and evaluate differential clinical outcomes.

Methods

We studied 327 first-time ICD recipients between 2011 and 2015. All patients receiving a primary prevention ICD were optimized on guideline directed medical therapy (GDMT) prior to consideration for device implantation. Using multivariate logistic regression, we examined predictors of ICD implantation during acute hospitalization. Cox proportional hazard regression was used adjusting for patient characteristics to examine associations with clinical outcomes including complications, device therapy, heart failure re-admission, and death.

Results

Of all patients, 132 (40.3%) underwent ICD implantation during acute hospitalization, most frequently performed for secondary prevention (n = 76, 57.6%). The most common reason for acute hospitalization ICD implantation in primary prevention patients was an indication for pacing (n = 20, 35.7%). In multivariable adjusted models, secondary prevention indication, non-single chamber device, NYHA class IV symptoms, lower diastolic blood pressure, higher BUN, and lower hemoglobin were significant predictors of ICD implantation during an acute hospitalization. In univariate analysis, acute hospitalization ICD implantation was associated with a higher risk of heart failure re-admission (HR = 1.6, 95% CI 1.1–2.4) and mortality (HR = 3.0, 95% CI 1.1–8.0) but no difference in risk of ICD therapy (HR = 1.4, 95% CI 0.9–2.3) or adverse events (HR = 1.1, 95% CI 0.6–2.1). After multivariable adjustment for potential confounders, all outcomes were no different between acute hospitalization versus elective outpatient ICD recipients.

Conclusions

Among first-time ICD recipients, specific clinical characteristics predicted acute hospitalization ICD implantation. After adjustment for potential confounders, acute hospitalization ICD implantation was not associated with increased risk of morbidity or mortality.

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Title: Reasons for and predictors of acute hospitalization versus elective outpatient implantable cardioverter-defibrillator implantation and subsequent differential clinical outcomes
Authors: Marin Nishimura
Shiv Sab
Ulrika Birgersdotter-Green
David Krummen
Amir Schricker
Farshad Raissi
Kurt S. Hoffmayer
Gregory K. Feld
Jonathan C. Hsu
Publication date: 01-10-2017
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 1/2017
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-017-0283-1

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Reasons for and predictors of acute hospitalization versus elective outpatient implantable cardioverter-defibrillator implantation and subsequent differential clinical outcomes

Abstract

Background

Purpose

Methods

Results

Conclusions

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Abstract

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