Outcomes and costs of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death among the elderly.
نویسندگان
چکیده
BACKGROUND The clinical outcomes and costs of implantable cardioverter-defibrillators (ICDs) used for primary prevention of sudden cardiac death in nonexperimental settings are uncertain. OBJECTIVE The purpose of this study was to measure the health outcomes and costs among a nationally representative cohort of elderly, primary-prevention ICD recipients. METHODS We collected health-care cost and utilization data from all Medicare beneficiaries hospitalized for congestive heart failure (CHF) who had received primary-prevention ICDs between October 2003 and September 2005 as well as propensity-score-matched control Medicare beneficiaries hospitalized for CHF during the same period. A multivariable Cox proportional hazards model was fitted to the cohort, which comprised 7125 ICD recipients and 7125 controls and which was followed through December 2005. Medicare claims in the first year inclusive of the index hospitalization were used to assess differences in health-care costs. RESULTS ICD receipt was associated with a significant reduction in mortality (adjusted hazard ratio = 0.62, 95% confidence interval 0.58-0.67). ICD patients had higher median hospital costs in the first 30 days after initial hospitalization (median difference = $41,542, P <.001) and at 1 year (median difference = $41,503, P <.001) as well as higher outpatient and physician costs at 6 months (median difference = $1828, P <.001). CONCLUSIONS ICD implantation was associated with reduced mortality in a nonexperimental, elderly, primary-prevention patient population hospitalized for CHF. The additional health-care costs of ICD implantation were substantial but comparable to published cost-effectiveness models that have projected ICDs to be cost-effective.
منابع مشابه
Preventing sudden death: implantable cardioverter-defibrillators in elderly cardiac patients.
Much of the public was introduced to the implantable cardioverter-defibrillator (ICD) when Vice President Cheney, a survivor of four heart attacks, received the device in 2001. Although ICDs were initially limited to patients with previous cardiac arrests or arrhythmias, more recent studies have demonstrated that ICDs can prevent sudden cardiac death in patients who have not had a cardiac arres...
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متن کاملComparison of Inappropriate Shocks and Other Health Outcomes Between Single- and Dual-Chamber Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Im
متن کامل
Comparison of Inappropriate Shocks and Other Health Outcomes Between Single‐ and Dual‐Chamber Implantable Cardioverter‐Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter‐Defibrillators
BACKGROUND In US clinical practice, many patients who undergo placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death receive dual-chamber devices. The superiority of dual-chamber over single-chamber devices in reducing the risk of inappropriate ICD shocks in clinical practice has not been established. The objective of this study was to compar...
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Patients who are on a waiting list for cardiac transplantation often have a clinical profile that satisfies current recommendations for the implantation of an implantable cardioverter-defibrillator for the primary prevention of sudden death. The prospect that transplantation may take place within the short-to-medium term puts the effectiveness of this therapy in doubt. We investigated the incid...
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ورودعنوان ژورنال:
- Heart rhythm
دوره 5 5 شماره
صفحات -
تاریخ انتشار 2008