Termination of arrhythmias by anti-tachycardia pacing is associated with very low healthcare utilization compared to shock therapy in patients with an implantable cardioverter defibrillator

Purpose: To assess healthcare utilization (HCU) associated with implantable cardioverter defibrillator (ICD) treatment of arrhythmias. Methods: An analysis of HCU was conducted for 1902 patients enrolled in the ADVANCEIII trial: 84.0% male, age 65±11, 74.9%, primary prevention, 28.7% single chamber, 30.6% dual chamber and 40.7% triple chamber ICDs. All Emergency Room visits (ER), unscheduled office visits and hospitalizations within 7 days of an ICD treated arrhythmia were considered to be associated with ICD therapy. Enrollment took place between 2008 and 2010 in 94 centers in Europe, Middle East, South Africa and Russia. Subjects were monitored for 12 months and data were collected during a baseline visit and every 3 months after. Anti-Tachycardia Pacing (ATP) during capacitor charge was programmed ON in all patients. All arrhythmias were reviewed and classified by an independent committee. Delivery of multiple ICD therapies within a 24 hours was considered as a single event. Results: After 1year of follow up, 811 events with at least an ICD treated episode occurred in 307 (16.1%) patients. Out of the total events, 454 (56%) events in 163 patients were treated only by ATP and 357 (44%) events in 211 patients were treated with at least a shock. Of the 357 shocked episodes, 247 (69.2%) were appropriate and 110 (30.8%) were inappropriate; 99 (26%) shocked events have an associated HCU within 7 days, 25% of appropriate shocks and 27% of inappropriate shocks. No HCU occurred within 7 days for 448 (99%) events treated with only ATP (Figure 1). Figure 1. Details on HCU distribution Conclusions: ICD shocks are more likely to result in a healthcare utilization compared to ATP therapy. Thus, using ATP therapies for ICD patients could avoid additional costs for health care systems and reduce the organizational burden of hospitals.