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

Research output: Contribution to journalArticle

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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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Cardiac Resynchronization Therapy
Defibrillators
Costs and Cost Analysis
Pneumothorax
Pericardiocentesis
Cardiac Tamponade
Pericardial Effusion
Hospital Costs
International Classification of Diseases
Punctures
Respiratory Insufficiency
Hematoma
Blood Vessels
Inpatients
Heart Failure
Stroke
Hemorrhage
Mortality

Keywords

  • cardiac resynchronization therapy defibrillator
  • complications
  • cost
  • mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Frequency of in-hospital adverse outcomes and cost utilization associated with cardiac resynchronization therapy defibrillator implantation in the United States. / Patel, Nilay; Viles-Gonzalez, Juan; Agnihotri, Kanishk; Arora, Shilpkumar; Patel, Nileshkumar J.; Aneja, Ekta; Shah, Mahek; Badheka, Apurva O.; Pothineni, Naga Venkata; Kancharla, Krishna; Mulpuru, Siva; Noseworthy, Peter; Kusumoto, Fred; Cha, Yong-Mei; Deshmukh, Abhishek J.

In: Journal of Cardiovascular Electrophysiology, Vol. 29, No. 10, 01.10.2018, p. 1425-1435.

Research output: Contribution to journalArticle

Patel, N, Viles-Gonzalez, J, Agnihotri, K, Arora, S, Patel, NJ, Aneja, E, Shah, M, Badheka, AO, Pothineni, NV, Kancharla, K, Mulpuru, S, Noseworthy, P, Kusumoto, F, Cha, Y-M & Deshmukh, AJ 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, vol. 29, no. 10, pp. 1425-1435. https://doi.org/10.1111/jce.13701
Patel, Nilay ; Viles-Gonzalez, Juan ; Agnihotri, Kanishk ; Arora, Shilpkumar ; Patel, Nileshkumar J. ; Aneja, Ekta ; Shah, Mahek ; Badheka, Apurva O. ; Pothineni, Naga Venkata ; Kancharla, Krishna ; Mulpuru, Siva ; Noseworthy, Peter ; Kusumoto, Fred ; Cha, Yong-Mei ; Deshmukh, Abhishek J. / Frequency of in-hospital adverse outcomes and cost utilization associated with cardiac resynchronization therapy defibrillator implantation in the United States. In: Journal of Cardiovascular Electrophysiology. 2018 ; Vol. 29, No. 10. pp. 1425-1435.
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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.",
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AU - Viles-Gonzalez, Juan

AU - Agnihotri, Kanishk

AU - Arora, Shilpkumar

AU - Patel, Nileshkumar J.

AU - Aneja, Ekta

AU - Shah, Mahek

AU - Badheka, Apurva O.

AU - Pothineni, Naga Venkata

AU - Kancharla, Krishna

AU - Mulpuru, Siva

AU - Noseworthy, Peter

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AU - Cha, Yong-Mei

AU - Deshmukh, Abhishek J.

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N2 - 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.

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