Author + information
- Received June 1, 2017
- Revision received September 14, 2017
- Accepted September 14, 2017
- Published online February 19, 2018.
- Prashanthan Sanders, MBBS, PhDa,∗ (, )
- Allison T. Connolly, PhDb,
- Yelena Nabutovsky, MScb,
- Avi Fischer, MDb and
- Mohammad Saeed, MDc
- aCentre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- bAbbott, Chicago, Illinois
- cTexas Heart Institute, Houston, Texas
- ↵∗Address for correspondence:
Dr. Prashanthan Sanders, Centre for Heart Rhythm Disorders, Department of Cardiology, Royal Adelaide Hospital, North Terrace Adelaide, SA 5000, Australia.
Objectives The purpose of this study was to evaluate the effect of these therapies on healthcare utilization in a large patient cohort.
Background Antitachycardia pacing (ATP) terminates ventricular tachycardia and avoids delivery of high-voltage shocks. Few data exist on the impact of shocks on healthcare resource utilization compared with ATP.
Methods PROVIDE (Programming Implantable Cardioverter Defibrillators in Patients With Primary Prevention Indication) was a prospective study of patients who received an implantable cardioverter-defibrillator (ICD) for primary prevention at 97 U.S. centers (2008 to 2010). We categorized the PROVIDE patients by the type of therapy delivered: no therapy, ATP only, or at least 1 shock. All ICD therapies, hospitalizations, and deaths were adjudicated. Cumulative cardiac hospitalizations, risk of all-cause death or cardiac hospitalization, and annual costs were compared between groups.
Results Of the 1,670 patients in PROVIDE, followed up for 18.1 ± 7.6 months, 1,316 received no therapy, 152 had ATP only, and 202 received at least 1 shock. Patients receiving no therapy and those receiving only ATP had a lower cumulative hospitalization rate and were at lower risk for death or hospitalization (hazard ratio: 0.33 [p < 0.001] and 0.33 [p < 0.002], respectively). The cost of hospitalization was $2,874 per patient-year (95% confidence interval: $877 to $5,140; p = 0.002) higher for those receiving at least 1 shock than for those who received ATP only. There was no difference in outcomes or cost between patients receiving only ATP and those without therapy.
Conclusions Among patients implanted with an ICD for primary prevention, those who received only ATP therapy had reduced hospitalizations, mortality, and cost compared with those who received at least 1 high-voltage shock and had equivalent outcomes to patients who did not require any therapy. (Programming Implantable Cardioverter Defibrillators in Patients With Primary Prevention Indication [PROVIDE]; NCT00743522)
- antitachycardia pacing
- healthcare resource utilization
- implantable cardioverter-defibrillator
This work was supported by Abbott (St. Jude Medical). Dr. Sanders has served on advisory boards for Biosense-Webster, Medtronic, St. Jude Medical, Boston Scientific, and CathRx; received research funding from Medtronic, St. Jude Medical, Boston Scientific, Biotronik, and Sorin; and received consulting or lecture fees from Biosense-Webster, Medtronic, St. Jude Medical, and Boston Scientific. Dr. Sanders is supported by a practitioner fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. Dr. Connolly, Ms. Nabutovsky, and Dr. Fischer are employees of Abbott. Dr. Saeed has reported that he has no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 1, 2017.
- Revision received September 14, 2017.
- Accepted September 14, 2017.
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