HOSPITAL READMISSION IN PATIENTS TREATED WITH TIERED-THERAPY IMPLANTABLE DEFIBRILLATORS

Background We wished to determine the incidence, reasons, casts, and p redictors of cardiac-related hospital readmission in patients with tie red-therapy implantable defibrillators. Hospital readmission in patien ts with defibrillators reduces their quality of life and increases the cost associated with such therapy. Methods and Results We retrospecti vely studied 65 consecutive local patients (median age, 67 years; medi an ejection fraction, 0.34) who underwent tiered-therapy defibrillator implantation at this institution. Patients were followed for a median of 19 months (interquartile range, 10 to 27 months). The cause, durat ion, costs, and predictors of cardiac-related rehospitalizations were analyzed. There were 76 cardiac admissions for 34 patients. The rate o f cardiac-related hospital readmission was 0.72 per patient-year of fo llow-up. Arrhythmia-related admissions accounted for 33 of such admiss ions in 23 patients. Actuarial freedom from cardiac-related admissions was 0.57 and 0.40 at 1 and 2 years, respectively. The median length o f stay for hospital readmissions was 5 days (interquartile range, 3 to 8 days). The median cost per admission was $5842 (interquartile range , $3549 to $12 170). The time to first readmission and the total rehos pitalization time per year of follow-up were associated with a poor pr eimplant New York Heart Association functional class. Readmission for cardiac arrhythmias was nor predicted by clinical parameters. Conclusi ons Rehospitalization For cardiac reasons is common in patients receiv ing implantable defibrillators and is responsible for substantial reso urce consumption. The need for readmission for arrhythmia-related reas ons cannot be predicted by clinical parameters at the time of device i mplantation.