Detect Long-term Complications After ICD Replacement (DECODE): Rationale and Study Design of a Multicenter Italian Registry.
The replacement of implantable cardioverter-defibrillators (ICDs) may give rise to considerable clinical consequences, the importance of which is underrated by the medical community. Replacement-related adverse events are difficult to identify and require monitoring of both short-term complications and long-term patient outcome. The aim of this study is to perform a structured evaluation of both short- and long-term adverse events and a cost analysis of consecutive ICD replacement procedures. Detect Long-term Complications After ICD Replacement (DECODE) is a prospective, single-arm, multicenter cohort study designed to estimate long-term complication rates (at 12 months and 5 years) in patients undergoing ICD generator replacement. The study will also evaluate predictors of complications, patient management before and during the replacement procedure in clinical practice, and the costs related to use of health care resources. About 800 consecutive patients with standard indications for ICD generator replacement will be enrolled in this study. The decision to undertake generator replacement/upgrade will be made according to the investigators' own judgment (which will be recorded). Patients will be followed for 60 months through periodic in-hospital examinations or remote monitoring. Detailed data on complications related to ICD replacement in current clinical practice are still lacking. The analysis of adverse events will reveal the value of new preventive strategies, thereby yielding both clinical and economic benefits. Moreover, assessment of complication rates after ICD replacement in a real-life setting will help estimate the actual long-term cost of ICD therapy and assess the real impact of increasing ICD longevity on cost-effectiveness.
Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Igor
I
Diemberger
Cardiovascular Department, Fondazione di Ricerca e Cura "Giovanni Paolo II," Catholic University of the Sacred Heart, Campobasso, Italy.
Quintino
Q
Parisi
Cardiac Electrophysiology and Pacing Unit, Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
Paolo
P
De Filippo
Cardiovascular Sciences Department, Catholic University of Sacred Heart, Rome, Italy.
Maria Lucia
ML
Narducci
Arrhythmia and Electrophysiology Unit, Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
Francesco
F
Zanon
Department of Cardiology, Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.
Domenico Rosario
DR
Potenza
Department of Cardiology, A.O.U. Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Gianfranco
G
Ciaramitaro
CRM Division, Boston Scientific Italia, Milan, Italy.
Maurizio
M
Malacrida
Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Giuseppe
G
Boriani
Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Mauro
M
Biffi
D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics; D020878:Device Removal / Q000009:adverse effects* / Q000191:economics; D004554:Electric Countershock / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics / Q000209:etiology*; D011446:Prospective Studies; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome