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

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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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Abbreviations

ICD:

Implantable cardioverter-defibrillator

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

SCD:

Sudden cardiac death

NYHA:

New York Heart Association

CI:

Confidence interval

CRT-D:

Cardiac resynchronization therapy with defibrillator

ICD:

Implantable cardioverter-defibrillator

HR:

Hazard ratio

OR:

Odds ratio

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Authors and Affiliations

  1. Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA

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

Authors
  1. Marin Nishimura
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  2. Shiv Sab
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  3. Ulrika Birgersdotter-Green
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  4. David Krummen
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  5. Amir Schricker
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  6. Farshad Raissi
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  7. Kurt S. Hoffmayer
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  8. Gregory K. Feld
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  9. Jonathan C. Hsu
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Corresponding author

Correspondence to Jonathan C. Hsu.

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Conflict of interest

The UCSD Cardiac Electrophysiology Fellowship Training Program receives support from Medtronic Inc., St. Jude Medical Inc., Biotronik Inc., Boston-Scientific Inc., and Biosense-Webster Inc. Dr. Jonathan C. Hsu reports receiving honoraria from Medtronic, St. Jude Medical, and Biotronik and research grants from Biosense-Webster and Biotronik.

Research involving human participants and/or animals

The UCSD Human Research Protection Program approved analysis of the data from our institution for this study.

Informed consent

Owing to the retrospective and observational nature of this study, written informed consent was waived.

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Nishimura, M., Sab, S., Birgersdotter-Green, U. et al. Reasons for and predictors of acute hospitalization versus elective outpatient implantable cardioverter-defibrillator implantation and subsequent differential clinical outcomes. J Interv Card Electrophysiol 50, 85–93 (2017). https://doi.org/10.1007/s10840-017-0283-1

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  • DOI: https://doi.org/10.1007/s10840-017-0283-1

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