title: Greater mortality risk among patients with delayed follow-up after implantable cardioverter defibrillator procedures.
abstract: BACKGROUND
  Substantial numbers of deaths occur among implantable cardioverter defibrillator (ICD) recipients. Timely follow-up after ICD implantation might improve patient outcomes. Our objective was to examine follow-up care and outcomes among patients undergoing ICD implantation.
  
  
  METHODS
  We compared patient characteristics and outcomes of those with late (> 12 weeks) vs early defibrillator clinic follow-up after ICD implantation in the Ontario ICD Database from 2007 to 2011. We examined the effect of ICD clinic follow-up visits after implant compared with primary care physician tracer on mortality outcomes using time-varying covariate analyses.
  
  
  RESULTS
  Among 8096 ICD recipients (age 64.6 ± 12.6 years), 1145 (14%) received delayed follow-up. Patients with early ICD clinic follow-up experienced reduced risk of all-cause mortality, with a hazard ratio [HR] of 0.69 (95% confidence interval [CI], 0.50-0.95; P = 0.023) adjusted for clinical factors, primary care visits after discharge, and distance to follow-up centre. Early ICD clinic follow-up was associated with a reduction in out-of-hospital death with adjusted HR of 0.52 (95% CI, 0.36-0.76; P = 0.001) but not with a significant change in cardiovascular hospitalizations. In a tracer analysis, early primary care physician follow-up was associated with a nonsignificant trend toward increased mortality with an adjusted HR of 1.48 (95% CI, 0.97-2.25; P = 0.072). Reduced estimated glomerular filtration rate, secondary prevention or replacement devices, myocardial ischemia, smoking, and greater geographic distance to the implanting centre increased the odds of delayed follow-up.
  
  
  CONCLUSIONS
  After device implantation, early defibrillator clinic follow-up was associated with reduced risk of all-cause and out-of-hospital death compared with those experiencing delayed follow-up.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Zachary W M
authors.initials: ZW
authors.lastname: Laksman
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.affiliation: Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Simpson
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eugene
authors.initials: E
authors.lastname: Crystal
authors.affiliation: Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Healey
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: dlee@ices.on.ca.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000601:surgery*; D003266:Continuity of Patient Care; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario / Q000453:epidemiology; D011320:Primary Health Care; D012042:Registries; D012111:Residence Characteristics; D012907:Smoking / Q000453:epidemiology; D013997:Time Factors