Stefan G Spitzer1,2, Dietrich Andresen3, Karl-Heinz Kuck4, Karlheinz Seidl5, Lars Eckardt6, Michael Ulbrich7, Johannes Brachmann8, Bernd-Dieter Gonska9, Ellen Hoffmann10, Alexander Bauer11, Matthias Hochadel12, Jochen Senges12. 1. Praxisklinik Herz und Gefäße, Akademische Lehrpraxisklinik der TU Dresden, Forststraße 3, 01099 Dresden, Germany. 2. Brandenburgische Technische Universität Cottbus-Senftenberg, Senftenberg, Germany. 3. Klinikum Am Urban, Berlin, Germany. 4. Asklepios Klinik St Georg, Hamburg, Germany. 5. Klinikum Ludwigshafen gGmbH, Ludwigshafen am Rhein, Germany. 6. University Hospital, Münster, Germany. 7. Klinikum Großhadern, Munich, Germany. 8. Klinikum Coburg GmbH, Coburg, Germany. 9. Vincentius Hospital, Karlsruhe, Germany. 10. Klinikum München Bogenhausen, Munich, Germany. 11. Diakonie-Klinikum Schwäbisch Hall gGmbH, Schwäbisch Hall, Germany. 12. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Abstract
AIMS: To analyse the long-term safety of implantable cardioverter defibrillators (ICDs) in patients discharged within 24 h or after 2- 5-day hospitalization, respectively, after complication-free implantation, in circumstances of actual care. METHODS AND RESULTS: Patients in the multicentre, nationwide German DEVICE registry were contacted 12-15 months after their first ICD implantation or device replacement. Data were collected on complications, potential arrhythmic events, syncope, resuscitation, ablation procedures, cardiac events, hospitalizations, heart failure status, change of medication, and quality of life. Of 2356 patients from 43 centres, 527 patients were discharged within 24 h and 1829 were hospitalized routinely for >24 h after complication-free implantations. The disease profiles and rates of co-morbidities were similar at baseline for both cohorts. During between 384 and 543 days of follow-up, there were no significant differences between the groups in terms of complications, hospitalizations, or quality of life. One-year rates of death were 4.5% in patients discharged early compared with 7.2% in hospitalized patients (hazard ratio 0.65; 95% confidence interval 0.42-1.02; P = 0.052). Rates of major adverse cardiovascular events or defibrillator events were not higher in patients discharged after 24 h. In both groups, a high rate of patients declared that they would opt for the procedure again in the same situation. CONCLUSION: Data from a large-scale registry reflecting current day-to-day practice in Germany suggest that most patients can be discharged safely within 24 h of successful ICD implantation if there are no procedure-related events. Follow-up data up to 1.5 years after implantation did not raise long-term safety concerns. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To analyse the long-term safety of implantable cardioverter defibrillators (ICDs) in patients discharged within 24 h or after 2- 5-day hospitalization, respectively, after complication-free implantation, in circumstances of actual care. METHODS AND RESULTS: Patients in the multicentre, nationwide German DEVICE registry were contacted 12-15 months after their first ICD implantation or device replacement. Data were collected on complications, potential arrhythmic events, syncope, resuscitation, ablation procedures, cardiac events, hospitalizations, heart failure status, change of medication, and quality of life. Of 2356 patients from 43 centres, 527 patients were discharged within 24 h and 1829 were hospitalized routinely for >24 h after complication-free implantations. The disease profiles and rates of co-morbidities were similar at baseline for both cohorts. During between 384 and 543 days of follow-up, there were no significant differences between the groups in terms of complications, hospitalizations, or quality of life. One-year rates of death were 4.5% in patients discharged early compared with 7.2% in hospitalized patients (hazard ratio 0.65; 95% confidence interval 0.42-1.02; P = 0.052). Rates of major adverse cardiovascular events or defibrillator events were not higher in patients discharged after 24 h. In both groups, a high rate of patients declared that they would opt for the procedure again in the same situation. CONCLUSION: Data from a large-scale registry reflecting current day-to-day practice in Germany suggest that most patients can be discharged safely within 24 h of successful ICD implantation if there are no procedure-related events. Follow-up data up to 1.5 years after implantation did not raise long-term safety concerns. Published on behalf of the European Society of Cardiology. All rights reserved.