What are the professional and logistic demands to appropriately follow patients with an implantable cardioverter-defibrillator?
OBJECTIVE
To determine events during follow-up of patients with implantable cardioverter-defibrillators (ICD) and the specific experience cardiologists need for trouble-shooting.


METHODS
Prospective evaluation of all patient visits in an outpatient clinic.


METHODS
University hospital, single centre performing ICD controls in a region of 1.5 Mio inhabitants.


METHODS
A total of 351 patients with 1118 consecutive visits during 14 months.


METHODS
Classification of events according to predefined training levels.


METHODS
Skill levels A: simple visit, e.g. for switching the device 'off'. B: normal visit, no further measures taken (no device reprogramming), even though the patient might have experienced ICD interventions. C: complex visit, electrophysiologist actively involved. Correlation of these levels with timing (routine, emergency on/off office hours) and reason of visits.


RESULTS
Seventy-six per cent of visits were scheduled routine visits, 5% performed within 24 h because of shocks, 19% performed for other reasons (shock tests; switching the device 'off/on'; reported dizziness, syncope, palpitations without ICD interventions). Required skill levels were A in 44 (4%), B in 796 (71%) and C in 278 (25%) visits. Emergency visits were more often classified as level C (60%) than regular visits (20%), Skill level C was more often encountered during emergency (30%) than during regular visits (6%) (both P = 0.001).


CONCLUSIONS
Our study suggests that for standard follow-up in patients without obvious problems, a cardiologist might be sufficient, whereas presentations due to/with clinical problems most likely will need the expertise of an electrophysiologist.
Schaer
B A
BA
Department of Cardiology, University Hospital, Basel, Switzerland.
Sticherling
C
C
Osswald
S
S
D039602:After-Hours Care; D016507:Cardiology Service, Hospital / Q000458:organization & administration / Q000592:standards*; D002983:Clinical Competence; D017147:Defibrillators, Implantable; D004630:Emergencies; D006302:Health Services Research; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D010044:Outpatient Clinics, Hospital / Q000592:standards; D011446:Prospective Studies; D013557:Switzerland