title: Health care utilisation after defibrillator implantation for primary prevention according to the guidelines in 2 Dutch academic medical centres.
abstract: BACKGROUND
  The benefit of implantable defibrillators (ICDs) for primary prevention remains debated. We analysed the implications of prophylactic ICD implantation according to the guidelines in 2 tertiary hospitals, and made a healthcare utilisation inventory.
  
  
  METHODS
  The cohort consisted of all consecutive patients with coronary artery disease (CAD) or dilated cardiomyopathy (DCM) receiving a primary prophylactic ICD in a contemporary setting (2004-2008). Follow-up was obtained from hospital databases, and mortality checked at the civil registry. Additional data came from questionnaires sent to general practitioners.
  
  
  RESULTS
  There were no demographic differences between the 2 centres; one had proportionally more CAD patients and more resynchronisation therapy (CRT-D). The 587 patients were followed over a median of 28 months, and 50 (8.5%) patients died. Appropriate ICD intervention occurred in 123 patients (21%). There was a small difference in intervention-free survival between the 2 centres. The questionnaires revealed 338 hospital admissions in 52% of the responders. Device-related admissions happened on 68 occasions, in 49/276 responders. The most frequently reported ICD-related admission was due to shocks (20/49 patients); for other cardiac problems it was mainly heart failure (52/99). Additional outpatient visits occurred in 19%.
  
  
  CONCLUSIONS
  Over a median follow-up of 2 years, one fifth of prophylactic ICD patients receive appropriate interventions. A substantial group undergoes readmission and additional visits. The high number of admissions points to a very ill population. Overall mortality was 8.5%. The 2 centres employed a similar procedure with respect to patient selection. One centre used more CRT-D, and observed more appropriate ICD interventions.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, PO Box 2040, 3000, CA, the Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Smith
authors.forename: P F
authors.initials: PF
authors.lastname: van Dessel
authors.forename: D A M J
authors.initials: DA
authors.lastname: Theuns
authors.forename: A
authors.initials: A
authors.lastname: Muskens-Heemskerk
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: A A
authors.initials: AA
authors.lastname: Wilde
authors.forename: L
authors.initials: L
authors.lastname: Jordaens