title: Differences Between Access to Follow-Up Care and Inappropriate Shocks Based on Insurance Status of Implantable Cardioverter Defibrillator Recipients.
abstract: Differences in implantable cardioverter defibrillator (ICD) utilization based on insurance status have been described, but little is known about postimplant follow-up patterns associated with insurance status and outcomes. We collected demographic, clinical, and device data from 119 consecutive patients presenting with ICD shocks. Insurance status was classified as uninsured/Medicaid (uninsured) or private/Health Maintenance Organization /Medicare (insured). Shock frequencies were analyzed before and after a uniform follow-up pattern was implemented regardless of insurance profile. Uninsured patients were more likely to present with an inappropriate shock (63% vs 40%, p = 0.01), and they were more likely to present with atrial fibrillation (AF) as the shock trigger (37% vs 19%, p = 0.04). Uninsured patients had a longer interval between previous physician contact and index ICD shock (147 ± 167 vs 83 ± 124 days, p = 0.04). Patients were followed for a mean of 521 ± 458 days after being enrolled in a uniform follow-up protocol, and there were no differences in the rate of recurrent shocks based on insurance status. In conclusion, among patients presenting with an ICD shock, underinsured/uninsured patients had significantly longer intervals since previous physician contact and were more likely to present with inappropriate shocks and AF, compared to those with private/Medicare coverage. After the index shock, both groups were followed uniformly, and the differences in rates of inappropriate shocks were mitigated. This observation confirms the importance of regular postimplant follow-up as part of the overall ICD management standard.
authors.affiliation: Chicago Cardiology Institute, Schaumburg, Illinois.
authors.forename: Solomon J
authors.initials: SJ
authors.lastname: Sager
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Chris
authors.initials: C
authors.lastname: Healy
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Archana
authors.initials: A
authors.lastname: Ramireddy
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Harold
authors.initials: H
authors.lastname: Rivner
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Viles Gonzalez
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: James O
authors.initials: JO
authors.lastname: Coffey
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Natalia
authors.initials: N
authors.lastname: Rossin
authors.affiliation: Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Ka M
authors.initials: KM
authors.lastname: Lo
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Myerburg
authors.affiliation: Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: rmitrani@med.miami.edu.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Mitrani
mesh_terms: D000359:Aftercare; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000628:therapy*; D001281:Atrial Fibrillation / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004868:Equipment Failure; D005260:Female; D006279:Health Maintenance Organizations; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D006278:Medicare; D008875:Middle Aged; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000628:therapy; D014481:United States; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000628:therapy