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Health care utilisation after defibrillator implantation for primary prevention according to the guidelines in 2 Dutch academic medical centres

(2011) NETHERLANDS HEART JOURNAL. 19(10). p.405-411
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Abstract
The benefit of implantable defibrillators (ICDs) for primary prevention remains debated. We analysed the implications of prophylactic ICD implantation according to the guidelines in 2 tertiary hospitals, and made a healthcare utilisation inventory. The cohort consisted of all consecutive patients with coronary artery disease (CAD) or dilated cardiomyopathy (DCM) receiving a primary prophylactic ICD in a contemporary setting (2004-2008). Follow-up was obtained from hospital databases, and mortality checked at the civil registry. Additional data came from questionnaires sent to general practitioners. There were no demographic differences between the 2 centres; one had proportionally more CAD patients and more resynchronisation therapy (CRT-D). The 587 patients were followed over a median of 28 months, and 50 (8.5%) patients died. Appropriate ICD intervention occurred in 123 patients (21%). There was a small difference in intervention-free survival between the 2 centres. The questionnaires revealed 338 hospital admissions in 52% of the responders. Device-related admissions happened on 68 occasions, in 49/276 responders. The most frequently reported ICD-related admission was due to shocks (20/49 patients); for other cardiac problems it was mainly heart failure (52/99). Additional outpatient visits occurred in 19%. Over a median follow-up of 2 years, one fifth of prophylactic ICD patients receive appropriate interventions. A substantial group undergoes readmission and additional visits. The high number of admissions points to a very ill population. Overall mortality was 8.5%. The 2 centres employed a similar procedure with respect to patient selection. One centre used more CRT-D, and observed more appropriate ICD interventions.
Keywords
Coronary artery disease, Dilated cardiomyopathy, Complications, Health care resources, Implantable cardioverter defibrillator, Primary prevention, Mortality, Sudden cardiac death, Ventricular arrhythmias, SUDDEN CARDIAC DEATH, NONISCHEMIC DILATED CARDIOMYOPATHY, CARDIOVERTER-DEFIBRILLATOR, COST-EFFECTIVENESS, PROPHYLACTIC IMPLANTATION, MYOCARDIAL-INFARCTION, HEART-FAILURE, RESYNCHRONIZATION THERAPY, VENTRICULAR-TACHYCARDIA, HIGH-RISK

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Chicago
Smith, T, PF van Dessel, DAMJ Theuns, A Muskens-Heemskerk, RT van Domburg, AA Wilde, and Luc Jordaens. 2011. “Health Care Utilisation After Defibrillator Implantation for Primary Prevention According to the Guidelines in 2 Dutch Academic Medical Centres.” Netherlands Heart Journal 19 (10): 405–411.
APA
Smith, T, van Dessel, P., Theuns, D., Muskens-Heemskerk, A., van Domburg, R., Wilde, A., & Jordaens, L. (2011). Health care utilisation after defibrillator implantation for primary prevention according to the guidelines in 2 Dutch academic medical centres. NETHERLANDS HEART JOURNAL, 19(10), 405–411.
Vancouver
1.
Smith T, van Dessel P, Theuns D, Muskens-Heemskerk A, van Domburg R, Wilde A, et al. Health care utilisation after defibrillator implantation for primary prevention according to the guidelines in 2 Dutch academic medical centres. NETHERLANDS HEART JOURNAL. 2011;19(10):405–11.
MLA
Smith, T et al. “Health Care Utilisation After Defibrillator Implantation for Primary Prevention According to the Guidelines in 2 Dutch Academic Medical Centres.” NETHERLANDS HEART JOURNAL 19.10 (2011): 405–411. Print.
@article{8101390,
  abstract     = {The benefit of implantable defibrillators (ICDs) for primary prevention remains debated. We analysed the implications of prophylactic ICD implantation according to the guidelines in 2 tertiary hospitals, and made a healthcare utilisation inventory. 
The cohort consisted of all consecutive patients with coronary artery disease (CAD) or dilated cardiomyopathy (DCM) receiving a primary prophylactic ICD in a contemporary setting (2004-2008). Follow-up was obtained from hospital databases, and mortality checked at the civil registry. Additional data came from questionnaires sent to general practitioners. 
There were no demographic differences between the 2 centres; one had proportionally more CAD patients and more resynchronisation therapy (CRT-D). The 587 patients were followed over a median of 28 months, and 50 (8.5%) patients died. Appropriate ICD intervention occurred in 123 patients (21%). There was a small difference in intervention-free survival between the 2 centres. The questionnaires revealed 338 hospital admissions in 52% of the responders. Device-related admissions happened on 68 occasions, in 49/276 responders. The most frequently reported ICD-related admission was due to shocks (20/49 patients); for other cardiac problems it was mainly heart failure (52/99). Additional outpatient visits occurred in 19%. 
Over a median follow-up of 2 years, one fifth of prophylactic ICD patients receive appropriate interventions. A substantial group undergoes readmission and additional visits. The high number of admissions points to a very ill population. Overall mortality was 8.5%. The 2 centres employed a similar procedure with respect to patient selection. One centre used more CRT-D, and observed more appropriate ICD interventions.},
  author       = {Smith, T and van Dessel, PF and Theuns, DAMJ and Muskens-Heemskerk, A and van Domburg, RT and Wilde, AA and Jordaens, Luc},
  issn         = {1568-5888},
  journal      = {NETHERLANDS HEART JOURNAL},
  keywords     = {Coronary artery disease,Dilated cardiomyopathy,Complications,Health care resources,Implantable cardioverter defibrillator,Primary prevention,Mortality,Sudden cardiac death,Ventricular arrhythmias,SUDDEN CARDIAC DEATH,NONISCHEMIC DILATED CARDIOMYOPATHY,CARDIOVERTER-DEFIBRILLATOR,COST-EFFECTIVENESS,PROPHYLACTIC IMPLANTATION,MYOCARDIAL-INFARCTION,HEART-FAILURE,RESYNCHRONIZATION THERAPY,VENTRICULAR-TACHYCARDIA,HIGH-RISK},
  language     = {eng},
  number       = {10},
  pages        = {405--411},
  title        = {Health care utilisation after defibrillator implantation for primary prevention according to the guidelines in 2 Dutch academic medical centres},
  url          = {http://dx.doi.org/10.1007/s12471-011-0176-3},
  volume       = {19},
  year         = {2011},
}

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