title: Safety and Cost-Effectiveness of Same-Day Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator Implantation.
abstract: Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD) implantation improve morbidity and mortality in selected patients. Many centers still admit patients overnight. We evaluated the safety, feasibility, and cost savings of same-day CRT/ICD device implantation by performing a retrospective study of all consecutive elective CRT/ICD implants at a tertiary center from January 2009 to April 2013. All emergency and/or inpatient cases were excluded. Data were collected on baseline demographics, implantation indication, procedure details, complications (categorized as immediate [≤24 hours], short term [24 hours to 6 weeks], medium term [6 weeks to 4 months], and long term [>4 months]), and mortality (30 day and 1 year). Comparisons were made between those having planned same-day versus overnight stay procedures. A cost analysis was performed to evaluate cost savings of the same-day policy. A total of 491 devices were implanted during this period: 267 were elective (54 planned overnight, 213 planned same-day) of which 229 were CRT pacemakers or CRT defibrillators and 38 ICDs. There were 26 total overall complications (9.7%) with no significant differences between planned same-day versus planned overnight stay cohorts (9.4% vs 11.1%, p = 0.8) and specifically no differences in immediate, short-, medium-, and long-term complications at follow-up. The 30-day and 1-year mortality rates did not differ between the two groups. An overnight stay at our hospital costs $450 (£300); our cost saving during this period was $91,800 (£61,200). Same-day CRT/ICD implantation is safe, feasible, and associated with significant cost savings. It provides significant advantages for patients and health care providers, especially given the current financial climate.
authors.affiliation: Department of Medicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Gavin
authors.initials: G
authors.lastname: Atherton
authors.affiliation: Department of Medicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Department of Cardiology, University Hospital Coventry, Clifford Bridge Road, Coventry, United Kingdom.
authors.forename: Christopher James
authors.initials: CJ
authors.lastname: McAloon
authors.affiliation: Department of Medicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Bhaveek
authors.initials: B
authors.lastname: Chohan
authors.affiliation: Department of Medicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Dominic
authors.initials: D
authors.lastname: Heining
authors.affiliation: Department of Medicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Anderson
authors.affiliation: Department of Medicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Jethro
authors.initials: J
authors.lastname: Barker
authors.affiliation: Department of Medicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Harpal
authors.initials: H
authors.lastname: Randeva
authors.affiliation: Department of Medicine, Warwick Medical School, University of Warwick, Coventry, United Kingdom; Department of Cardiology, University Hospital Coventry, Clifford Bridge Road, Coventry, United Kingdom. Electronic address: faizel.osman@btinternet.com.
authors.forename: Faizel
authors.initials: F
authors.lastname: Osman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome