Indiresha Ramachandra1. 1. Division of Cardiology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44139, USA. indiresha_r@yahoo.com
Abstract
BACKGROUND: The number of implantable cardioverter defibrillator (ICD) replacements is increasing, which adds to patient risk and costs. OBJECTIVES: To understand the impact of increasing ICD longevity on need for replacements, costs, and some of the risks. METHODS: Using the Veterans Affairs records, veterans with ICD implants between June 1992 and April 2007 and dead as of April 2009 were identified. Data were obtained by retrospective records review. The longevity of each ICD was the duration from implant to explant. For each ICD, the longevity needed to avoid one replacement was defined as longevity of that ICD plus the longevity of the subsequent ICD. RESULTS: The study cohort had 164 patients with 301 ICD implants. Ninety-two patients had at least one ICD replacement. Two patients were excluded for missing data. Twenty-seven patients had an ICD explanted for reasons other than battery depletion. Sixty-three patients received 83 ICDs for battery depletion alone. Among 27 patients who had ICD replacements for other reasons, four patients may have avoided a device infection related to ICD replacement if the initial ICD had lasted 7 years. If all ICDs had lasted 5, 7, or 9 years, then 26%, 58%, and 84% of patients, respectively, would not have needed an ICD replacement. Also 17, 37, and 53 ICD replacements, respectively, would have been avoided, saving US$314,500-US$980,500 over 15 years at 2005 Medicare reimbursement rates. CONCLUSIONS: Prolongation of battery life to 7 or 9 years is important to reduce patient risks and decrease costs.
BACKGROUND: The number of implantable cardioverter defibrillator (ICD) replacements is increasing, which adds to patient risk and costs. OBJECTIVES: To understand the impact of increasing ICD longevity on need for replacements, costs, and some of the risks. METHODS: Using the Veterans Affairs records, veterans with ICD implants between June 1992 and April 2007 and dead as of April 2009 were identified. Data were obtained by retrospective records review. The longevity of each ICD was the duration from implant to explant. For each ICD, the longevity needed to avoid one replacement was defined as longevity of that ICD plus the longevity of the subsequent ICD. RESULTS: The study cohort had 164 patients with 301 ICD implants. Ninety-two patients had at least one ICD replacement. Two patients were excluded for missing data. Twenty-seven patients had an ICD explanted for reasons other than battery depletion. Sixty-three patients received 83 ICDs for battery depletion alone. Among 27 patients who had ICD replacements for other reasons, four patients may have avoided a device infection related to ICD replacement if the initial ICD had lasted 7 years. If all ICDs had lasted 5, 7, or 9 years, then 26%, 58%, and 84% of patients, respectively, would not have needed an ICD replacement. Also 17, 37, and 53 ICD replacements, respectively, would have been avoided, saving US$314,500-US$980,500 over 15 years at 2005 Medicare reimbursement rates. CONCLUSIONS: Prolongation of battery life to 7 or 9 years is important to reduce patient risks and decrease costs.
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