Hospital readmission in patients with implantable cardioverter-defibrillators.
BACKGROUND
Hospital readmissions are one of the important problems of patients with implantable cardioverter-defibrillators (ICD). Detailed analysis of the causes of re-hospitalizations may lead to improved management of ICD patients and eventually limit the number of hospital readmissions.


OBJECTIVE
Prospective analysis of repeat hospitalisations, their causes and time from discharge to first hospital readmission in a group of patients after ICD implantation. A search for predictors of rehospitalisation was also performed.


METHODS
Analysis involved 133 consecutive patients who underwent ICD implantation in the Department of Cardiology, PAM. Readmission causes were split into cardiac and non-cardiac. An index of repeat hospitalisation was calculated and parameters with a direct impact on rehospitalisation necessity were also evaluated.


RESULTS
One hundred and sixty-seven hospital readmissions of 72 (54%) patients were noted at mean 22+/-15 months after the primary hospitalisation. Rehospitalisation index per patient for the total follow-up period was 1.26, while for the first year of follow-up it was 0.69. In the case of 42 (32%) patients, 91 (54.5%) hospital readmissions were associated with arrhythmia. In 34 (25.6%) patients, 54 (32.3%) re-hospitalizations were not related to arrhythmia, while 20 (15%) patients were hospitalised 22 times (13.2%) for non-cardiac reasons. Mean time to the first readmission, regardless of the reason, was 9+/-9 months. Predominant causes of repeat hospitalisation were ventricular arrhythmias and worsening of heart failure. Patients with left ventricular ejection fraction (LVEF) below 30% and in functional NYHA class III were readmitted to hospital more frequently for reasons not related to arrhythmia.


CONCLUSIONS
Hospital readmissions for cardiac causes in patients after ICD implantation are still frequent. Most of them are caused by ventricular arrhythmia and heart failure. Low LVEF (<30%) and NYHA functional class > or =III are risk factors predicting repeat hospitalisations unrelated to arrhythmia.
Kaźmierczak
Jarosław
J
Klinika Kardiologii, Pomorska Akademia Medyczna, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland. j.kazmierczak@acx.pl
Zielonka
Joanna
J
Rzeuski
Ryszard
R
Peregud-Pogorzelska
Małgorzata
M
Goracy
Jarosław
J
Biernawska
Jowita
J
Sulikowski
Tadeusz
T
Kornacewicz-Jach
Zdzisława
Z
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000295:instrumentation*; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011044:Poland; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome