Study: Determinants of Outcomes Following Outpatient Placement of Implantable Cardioverter Defibrillators in a Medicare Advantage Population

November 2, 2018

An article titled, “Determinants of Outcomes Following Outpatient Placement of Implantable Cardioverter Defibrillators in a Medicare Advantage Population”, was published in Clinical Cardiology on August 8, 2018. Clinical Cardiology is the official journal of the American Society for Preventive Cardiology, and has been in print for four decades.o

The study was designed under the direction of Teresa L. Rogstad, MPH, of Humana, and Adam C. Powell, Ph.D., of HealthHelp. The research team sought to identify the determinants of one-year mortality and complications after implantable cardioverter defibrillator (ICD) placement, taking the type of implantation and patient characteristics into account.

Adult patients with Humana Medicare Advantage health plans who underwent outpatient ICD implantation between January 1, 2014, and September 30, 2015, were included in the analysis. Age, sex, the Charlson Comorbidity Index (CCI), prior-year hospitalization and emergency department (ED) visits, diabetes, heart failure, ischemic heart disease, and indicators of the need for pacing were evaluated as risk factors. Mortality and device-related complications were assessed at one year post-procedure using Kaplan-Meier and Cox Proportional Hazard analysis.

The study analyzed a population of 8,450 patients. One-year, event-free survival was 80.1%, based on an overall composite measure of complications and mortality. An adjusted survival analysis showed that in males aged 65 years or older, incremental increase in Charlson Comorbidity Index (CCI), heart failure, prior year hospitalization, emergency department visit, and prior year pacing procedure were significant predictors of mortality. Age greater than or equal to 65, male sex, and prior year hospitalization were significant predictors of a composite measure of device-related complications. CCI and prior hospitalization were significant predictors of a composite measure of any adverse outcome.

These results suggest that most patients in an older population do not experience adverse outcomes in the year following ICD implantation. The risk of mortality may be greater in men, patients over the age of 65, and patients with greater general morbidity, heart failure, or a history of a pacing procedure.

Cardiologist Jeffrey Simmons, M.D., who provided clinical guidance for the study, stated that “This study’s findings can be used to inform clinicians’ assessment of which patients are the most likely to do well in the first year after ICD implantation. However, even in a large population, the uptake of subcutaneous ICD remains too limited to allow us to fully assess its clinical benefits.”

The study’s corresponding author, Dr. Powell, remarked, “This study shows how the wealth of transactional data in our stewardship can be used for the benefit of medical science. We were able to share new findings on the outcomes experienced by people in their first year after ICD placement. The insights we generated would have been hiding within our databases, had HealthHelp and Humana not invested the resources necessary to unveil them.”

To read the article, please visit: https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.23041

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