Costs, Hospitalizations Go Down With ICDs Programmed With Longer Detection Intervals

August 05, 2014

CHICAGO, IL — Hospitalizations and mean hospital length of stay both went down significantly in patients with implantable cardioverter-defibrillators (ICD) set with prolonged vs standard detection intervals in exploratory analyses from the third Avoid Delivering Therapies for Non-sustained Arrhythmias in ICD Patients (ADVANCE 3) trial[1].

The trial had randomized 1902 patients implanted with their first ICDs, which had antitachycardia pacing and were programmed for prolonged (30 of 40) or standard (18 of 24) arrhythmia detection intervals. As previously reported by heartwire , 75% of implants were for primary prevention and 25% were for secondary prevention. All were programmed to detect arrhythmias with a cycle length of <320 ms.

In addition to the hospitalization results, the prespecified secondary end point of patient costs per year also dropped significantly in the current analyses, which appear in a research letter published in the August 6, 2014 issue of the Journal of the American Medical Association. The lead author is Dr Alessandro Proclemer (Azienda Ospedaliera Universitaria S Maria della Misericordia, Udine, Italy).

Those with ICDs programmed with longer detection intervals showed a prolonged time to first hospitalization (p=0.01) and number of hospitalizations from any cause per 100 patient-years. They also showed a mean $299/patient-year reduction in costs for all-cause hospitalization.

Incidence Rate Ratio (95% CI) for Hospitalizations and Mean Cost Ratio (95% CI) for Long-Detection Interval vs Standard Interval ICD Programming in ADVANCE 3 Trial

End points IRR (95% CI) p
Overall hospitalizations 0.84 (0.73–0.96) 0.005
Overall hospital length of stay 0.87 (0.83–0.91) <0.001
Overall hospitalization cost (mean cost ratio) 0.82 (0.82–0.82) <0.001

Very similar reductions in cardiovascular hospitalization, CV hospitalization length of stay, and CV hospitalization costs suggested that those end points drove the significant advantages shown for the corresponding "overall" end points in the prolonged-interval patients.

The findings "complement the demonstrated clinical effectiveness of the long-detection-interval strategy and come without additional costs for the hospitals or patients," according to the group, referring to the clinical effectiveness demonstrated by their own ADVANCE 3 primary results and the previously published MADIT-RIT trial.

ADVANCE III was funded by Medtronic. Proclemer reported no conflicts; disclosures for the other authors are listed in the paper.

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