Scholars@Duke publication: Follow-up of patients with new cardiovascular implantable electronic devices: is adherence to the experts' recommendations associated with improved outcomes?

Follow-up of patients with new cardiovascular implantable electronic devices: is adherence to the experts' recommendations associated with improved outcomes?

Publication , Journal Article

Hess, PL; Mi, X; Curtis, LH; Wilkoff, BL; Hegland, DD; Al-Khatib, SM

Published in: Heart Rhythm

August 2013

BACKGROUND: A 2008 expert consensus statement recommended an in-person follow-up visit between 2 and 12 weeks after the placement of a new cardiovascular implantable electronic device (CIED). OBJECTIVE: To assess outcomes associated with adherence to the experts' recommendations. METHODS: By using data from the National Cardiovascular Data Registry's (NCDR) ICD Registry linked to Medicare claims, we studied the association between follow-up within 2-12 weeks after CIED placement between January 1, 2005, and September 30, 2008, and all-cause mortality and risk of readmission within 1 year. RESULTS: Compared with patients who did not receive the recommended follow-up (n = 43,060), those who did (n = 30,256) were more likely to be older, white, to have received a cardiac resynchronization therapy-defibrillator device, to have more advanced heart failure symptoms, and to have nonischemic dilated cardiomyopathy. In Cox proportional hazards models adjusted for patient demographic and clinical factors, mortality was lower (hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.88-0.98; P = .005) but cardiovascular readmission was higher (HR 1.04; 95% CI 1.01-1.08; P = .012) among patients who received initial follow-up within 2-12 weeks after CIED placement compared with those who did not. There was no association between CIED follow-up and readmission for heart failure (HR 1.00; 95% CI 0.96-1.05; P = .878) or device-related infection (HR 1.22; 95% CI 0.98-1.51; P = .075). CONCLUSIONS: Follow-up within 2-12 weeks after CIED placement was independently associated with improved survival but increased cardiovascular readmission. Quality improvement initiatives designed to increase adherence to experts' recommendations may be warranted.