title: Long-term outcomes after event-free cardioverter defibrillator implantation: comparison between patients discharged within 24 h and routinely hospitalized patients in the German DEVICE registry.
abstract: OBJECTIVE
  To analyse the long-term safety of implantable cardioverter defibrillators (ICDs) in patients discharged within 24 h or after 2- 5-day hospitalization, respectively, after complication-free implantation, in circumstances of actual care.
  
  
  RESULTS
  Patients in the multicentre, nationwide German DEVICE registry were contacted 12-15 months after their first ICD implantation or device replacement. Data were collected on complications, potential arrhythmic events, syncope, resuscitation, ablation procedures, cardiac events, hospitalizations, heart failure status, change of medication, and quality of life. Of 2356 patients from 43 centres, 527 patients were discharged within 24 h and 1829 were hospitalized routinely for >24 h after complication-free implantations. The disease profiles and rates of co-morbidities were similar at baseline for both cohorts. During between 384 and 543 days of follow-up, there were no significant differences between the groups in terms of complications, hospitalizations, or quality of life. One-year rates of death were 4.5% in patients discharged early compared with 7.2% in hospitalized patients (hazard ratio 0.65; 95% confidence interval 0.42-1.02; P = 0.052). Rates of major adverse cardiovascular events or defibrillator events were not higher in patients discharged after 24 h. In both groups, a high rate of patients declared that they would opt for the procedure again in the same situation.
  
  
  CONCLUSIONS
  Data from a large-scale registry reflecting current day-to-day practice in Germany suggest that most patients can be discharged safely within 24 h of successful ICD implantation if there are no procedure-related events. Follow-up data up to 1.5 years after implantation did not raise long-term safety concerns.
authors.affiliation: Praxisklinik Herz und Gefäße, Akademische Lehrpraxisklinik der TU Dresden, Forststraße 3, 01099 Dresden, Germany.|Brandenburgische Technische Universität Cottbus-Senftenberg, Senftenberg, Germany.
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Spitzer
authors.affiliation: Klinikum Am Urban, Berlin, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Andresen
authors.affiliation: Asklepios Klinik St Georg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Klinikum Ludwigshafen gGmbH, Ludwigshafen am Rhein, Germany.
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Seidl
authors.affiliation: University Hospital, Münster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.affiliation: Klinikum Großhadern, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ulbrich
authors.affiliation: Klinikum Coburg GmbH, Coburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.affiliation: Vincentius Hospital, Karlsruhe, Germany.
authors.forename: Bernd-Dieter
authors.initials: BD
authors.lastname: Gonska
authors.affiliation: Klinikum München Bogenhausen, Munich, Germany.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
authors.affiliation: Diakonie-Klinikum Schwäbisch Hall gGmbH, Schwäbisch Hall, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bauer
authors.affiliation: Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015897:Comorbidity; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D061214:Patient Safety; D011446:Prospective Studies; D011475:Prosthesis Failure; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Clinical practice; Hospitalization; ICD; MACCE; Procedural complications