title: Follow-up of patients with new cardiovascular implantable electronic devices: is adherence to the experts' recommendations associated with improved outcomes?
abstract: BACKGROUND
  A 2008 expert consensus statement recommended an in-person follow-up visit between 2 and 12 weeks after the placement of a new cardiovascular implantable electronic device (CIED).
  
  
  OBJECTIVE
  To assess outcomes associated with adherence to the experts' recommendations.
  
  
  METHODS
  By using data from the National Cardiovascular Data Registry's (NCDR) ICD Registry linked to Medicare claims, we studied the association between follow-up within 2-12 weeks after CIED placement between January 1, 2005, and September 30, 2008, and all-cause mortality and risk of readmission within 1 year.
  
  
  RESULTS
  Compared with patients who did not receive the recommended follow-up (n = 43,060), those who did (n = 30,256) were more likely to be older, white, to have received a cardiac resynchronization therapy-defibrillator device, to have more advanced heart failure symptoms, and to have nonischemic dilated cardiomyopathy. In Cox proportional hazards models adjusted for patient demographic and clinical factors, mortality was lower (hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.88-0.98; P = .005) but cardiovascular readmission was higher (HR 1.04; 95% CI 1.01-1.08; P = .012) among patients who received initial follow-up within 2-12 weeks after CIED placement compared with those who did not. There was no association between CIED follow-up and readmission for heart failure (HR 1.00; 95% CI 0.96-1.05; P = .878) or device-related infection (HR 1.22; 95% CI 0.98-1.51; P = .075).
  
  
  CONCLUSIONS
  Follow-up within 2-12 weeks after CIED placement was independently associated with improved survival but increased cardiovascular readmission. Quality improvement initiatives designed to increase adherence to experts' recommendations may be warranted.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina 27715, USA. p.hess@duke.edu
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hess
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Mi
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
authors.forename: Donald D
authors.initials: DD
authors.lastname: Hegland
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
keywords: CI; CIED; CPT; CRT; CRT-D; DRG; EHRA; European Heart Rhythm Association; HR; HRS; Heart Rhythm Society; ICD; ICD-9-CM; Implantable cardioverter-defibrillator; International Classification of Diseases, Ninth Revision, Clinical Modification; Medicare; NCDR; National Cardiovascular Data Registry; Outcome; Outpatient; Registry; cardiac resynchronization therapy; cardiac resynchronization therapy-defibrillator; cardiovascular implantable electronic device; confidence interval; current procedural terminology; diagnosis-related group; hazard ratio; implantable cardioverter-defibrillator