Greater mortality risk among patients with delayed follow-up after implantable cardioverter defibrillator procedures
Laksman ZW, Krahn AD, Dorian P, Simpson CS, Crystal E, Healey JS, Khaykin Y, Wang X, Lee DS. Can J Cardiol. 2014; 30(6):598–605.
Background — Substantial numbers of deaths occur among implantable cardioverter defibrillator (ICD) recipients. Timely follow-up after ICD implantation may improve patient outcomes. The researchers' objective was to examine follow-up care and outcomes among patients undergoing ICD implantation.
Methods — The researchers compared patient characteristics and outcomes of those with late (>12 weeks) vs. early defibrillator clinic follow-up after ICD implantation in the Ontario ICD Database from 2007-2011. The researchers examined the impact of post-implant ICD clinic follow-up visits compared with primary care physician tracer on mortality outcomes using time-varying covariate analysis.
Results — Among 8096 ICD recipients (age 64.6 ± 12.6 years), 1145 (14%) received delayed follow-up. Patients with early ICD clinic follow-up experienced reduced risk of all-cause mortality, with hazards ratio [HR] 0.69 (95%CI; 0.50–0.95, p=0.023) adjusted for clinical factors, post-discharge primary care visits, and distance to follow-up center. Early ICD clinic follow-up was associated with a reduction in out-of-hospital death with adjusted HR 0.52 (95%CI; 0.36–0.76, p=0.001) but not with a significant change in cardiovascular hospitalizations. In a tracer analysis, early primary care physician follow-up was associated with a nonsignificant trend towards increased mortality with adjusted HR 1.48 (95%CI; 0.97–2.25, p=0.072). Reduced eGFR, secondary prevention or replacement devices, myocardial ischemia, smoking, and greater geographic distance to the implanting center increased the odds of delayed follow-up.
Conclusions — After device implantation, early defibrillator clinic follow-up was associated with reduced risk of all-cause and out-of-hospital death compared to those experiencing delayed follow-up. This study examines the relationship between delayed follow-up (>12 weeks) at a specialized implantable cardioverter defibrillator (ICD) clinic and outcomes in patients receiving ICDs. Among 8096 ICD recipients, 1145 patients (14%) received delayed follow-up. Patients experiencing early follow-up after ICD implantation exhibited reduced risk of all cause mortality, and reduced out-of-hospital death without a significant change in cardiovascular hospitalizations.