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Early followup care after ICD procedure associated with 31 per cent reduction in death: ICES study


Early followup in a specialized defibrillator clinic after an implantable cardioverter defibrillator (ICD) procedure is associated with a 31 per cent reduction in death, according to a study by researchers at the Institute for Clinical Evaluative Sciences (ICES).

Practice guidelines for ICD followup outline the need for a two to 12 week post-implant followup visit for early surveillance.

“Patients who have followup care within 12 weeks of their ICD procedure have a reduced risk of all-cause and out-of-hospital death compared to those experiencing delayed followup,” says lead author Dr. Douglas Lee, a senior scientist at ICES and cardiologist at the Peter Munk Cardiac Centre.

The study, published today in the Canadian Journal of Cardiology, compared the outcomes of patients who received an early outpatient followup visit in the defibrillator clinic after ICD implantation, to those receiving delayed followup (>12 weeks) in a time-dependent analysis.

In the study, researchers examined patients who underwent de novo ICD implant, or replacement procedures in Ontario from February 2007 to March 2011. Approximately one in seven patients did not undergo an in-person ICD clinic visit within 12 weeks after their defibrillator implant. There was no increase in hospitalizations among those receiving early followup in the specialized clinics.

Factors associated with delayed followup include:  

  • Access-related (e.g., greater distance from patient’s home to the clinic, mobility problems)
  • Patient-related factors affecting multiple organ systems (e.g., smoking, myocardial ischemia, worsened kidney function)
  • Device-related (e.g., visits for replacement devices leading to a false belief that additional followup visits are not necessary)

“Delayed followup was associated with increased risk of death, identifying a potentially serious gap in care. Implanting physicians should carefully counsel patients regarding the importance of a thorough post-ICD implant clinic evaluation, which cannot be substituted by generic primary care physician followup,” added Lee.

Authors: Zachary WM Laksman, Andrew D Krahn, Paul Dorian, Christopher S Simpson, Eugene Crystal, Jeffrey S Healey, Yaariv Khaykin, Xuesong Wang and Douglas S Lee.

The study “Greater mortality risk among patients with delayed followup after implantable cardioverter defibrillator procedures,” was published online today in the Canadian Journal of Cardiology.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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  • Deborah Creatura
  • Communications, ICES
  • [email protected]
  • (o) 416-480-4780 or (c) 647-406-5996 


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