Frequency of in-hospital adverse outcomes and cost utilization associated with cardiac resynchronization therapy defibrillator implantation in the United States

Nilay Patel, Juan Viles-Gonzalez, Kanishk Agnihotri, Shilpkumar Arora, Nileshkumar J. Patel, Ekta Aneja, Mahek Shah, Apurva O. Badheka, Naga Venkata Pothineni, Krishna Kancharla, Siva Mulpuru, Peter Noseworthy, Fred Kusumoto, Yong-Mei Cha, Abhishek J. Deshmukh

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Abstract

Background: The utilization of cardiac resynchronization therapy defibrillator (CRT-D) has increased significantly, since its initial approval for use in selected patients with heart failure. Limited data exist as for current trends in implant-related in-hospital complications and cost utilization. The aim of our study was to examine in-hospital complication rates associated with CRT-D and their trends over the last decade. Methods and Results: Using the Nationwide Inpatient Sample, we estimated 378 248 CRT-D procedures from 2003 to 2012. We investigated common complications, including mechanical, cardiovascular, pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with CRT-D, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. Mechanical complications (5.9%) were the commonest, followed by cardiovascular (3.6%), respiratory failure (2.4%), and pneumothorax (1.5%). Age (≥65 years), female gender (OR, 95% CI; P value) (1.08, 1.03-1.13; 0.001), and the Charlson score ≥3 (1.52, 1.45-1.60; <0.001) were significantly associated with increased mortality/complications. Conclusions: The overall complication rate in patients undergoing CRT-D has been increasing in the last decade. Age (≥65), female sex, and the Charlson score ≥3 were associated with higher complications. In patients who underwent CRT-D implantation, postoperative complications were associated with significant increases in cost.

Original languageEnglish (US)
Pages (from-to)1425-1435
Number of pages11
JournalJournal of Cardiovascular Electrophysiology
Volume29
Issue number10
DOIs
StatePublished - Oct 1 2018

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Keywords

  • cardiac resynchronization therapy defibrillator
  • complications
  • cost
  • mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Patel, N., Viles-Gonzalez, J., Agnihotri, K., Arora, S., Patel, N. J., Aneja, E., Shah, M., Badheka, A. O., Pothineni, N. V., Kancharla, K., Mulpuru, S., Noseworthy, P., Kusumoto, F., Cha, Y-M., & Deshmukh, A. J. (2018). Frequency of in-hospital adverse outcomes and cost utilization associated with cardiac resynchronization therapy defibrillator implantation in the United States. Journal of Cardiovascular Electrophysiology, 29(10), 1425-1435. https://doi.org/10.1111/jce.13701