Long-Term Risk for Device-Related Complications and Reoperations After Implantable Cardioverter-Defibrillator Implantation

• DOI: 10.7326/m15-2732
• Publication Date: 2016-05-02T22:30:31Z
• Authors: Isuru Ranasinghe; Craig S. Parzynski; James V. Freeman; Rachel P. Dreyer; Joseph S. Ross; Joseph G. Akar; Harlan M. Krumholz; Jeptha P. Curtis
• Keywords: Interquartile range; Cumulative incidence

Background: Long-term nonfatal outcomes after implantable cardioverter-defibrillator (ICD) placement are poorly defined. Objective: To determine the long-term risk for ICD-related complications requiring reoperation or hospitalization and reasons other than complications, to assess associated patient device characteristics. Design: Observational cohort study of ICD implantations from National Cardiovascular Data Registry registry linked with Medicare fee-for-service claims data. Setting: 1437 U.S. hospitals. Patients: 114 484 patients aged 65 years older (mean, 74.8 [SD, 6.2]; 72.4% male) receiving an first time 2006 2010 (single-chamber, 19.8%; dual-chamber, 41.3%; cardiac resynchronization therapy a defibrillator [CRT-D], 38.9%). Measurements: Rate cumulative incidence complications. Results: During median follow-up 2.7 (interquartile range, 1.8 3.9 years), 40 072 died, representing 12.6 (95% CI, 12.5 12.7) deaths per 100 patient-years follow-up. When death was accounted for, there were 6.1 (CI, 6.0 6.2) that required 3.8 4.0) reoperations Overall, 10 had Younger age at implantation (65 69 vs. >85 years) (hazard ratio [HR], 1.55 [CI, 1.43 1.69]), receipt CRT-D (HR, 1.38 1.31 1.45]) versus single-chamber device, female sex 1.16 1.12 1.21]), black race 1.14 1.05 1.23]) greatest increased risks Limitation: The analysis limited older. Conclusion: Patients have high rate device-related causes implantation. Risks strategies reduce them should be actively considered before Primary Funding Source: American College Cardiology Foundation's Registry.