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Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure

BACKGROUND: Inadvertent damage to leads for transvenous pacemakers, implantable cardioverter‐defibrillators, and cardiac resynchronization therapy defibrillators is an important complication associated with generator‐replacement procedures. We sought to estimate the incidence and costs associated wi...

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Autores principales: Nichols, Christine I., Vose, Joshua G., Mittal, Suneet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802471/
https://www.ncbi.nlm.nih.gov/pubmed/26873688
http://dx.doi.org/10.1161/JAHA.115.002813
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author Nichols, Christine I.
Vose, Joshua G.
Mittal, Suneet
author_facet Nichols, Christine I.
Vose, Joshua G.
Mittal, Suneet
author_sort Nichols, Christine I.
collection PubMed
description BACKGROUND: Inadvertent damage to leads for transvenous pacemakers, implantable cardioverter‐defibrillators, and cardiac resynchronization therapy defibrillators is an important complication associated with generator‐replacement procedures. We sought to estimate the incidence and costs associated with transvenous lead damage following cardiac implantable electronic device replacement. METHODS AND RESULTS: Using the Truven Health Analytics MarketScan Commercial Research Database, we identified health care claims between 2009 and 2013 for lead damage following generator replacement. Patients were identified by claims with a procedure code for cardiac implantable electronic device replacement and then evaluated for 1 year. All follow‐up visits for lead damage were identified, and incidence, risk factors, and hospitalization costs were determined. A total of 22 557 patients with pacemakers, 20 632 with implantable cardioverter‐defibrillators, and 2063 with cardiac resynchronization therapy defibrillators met selection criteria. Incidence of lead damage was 0.46% for pacemaker replacement, 1.27% for implantable cardioverter‐defibrillator replacement, and 1.94% for cardiac resynchronization therapy defibrillator replacement procedures (P<0.001). After adjusting for patient characteristics, patients with implantable cardioverter‐defibrillators and cardiac resynchronization therapy defibrillators demonstrated risk of lead damage that was, respectively, double (hazard ratio 2.00, 95% CI 1.57–2.55) and >2.5 times (hazard ratio 2.58, 95% CI 1.73–3.83) that of patients with pacemakers. Lead revision or repair procedures were associated with increased inpatient hospitalization costs (mean $19 959 for pacemaker, $24 885 for implantable cardioverter‐defibrillator, and $46 229 for cardiac resynchronization therapy defibrillator; P=0.048, Kruskal–Wallis test). CONCLUSIONS: These findings establish the first objective assessment of the incidence, risk factors, and economic burden of lead damage following cardiac implantable electronic device replacement in the United States. New care algorithms are warranted to avoid these events, which impose substantial burdens on patients, physicians, and payors.
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spelling pubmed-48024712016-04-08 Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure Nichols, Christine I. Vose, Joshua G. Mittal, Suneet J Am Heart Assoc Original Research BACKGROUND: Inadvertent damage to leads for transvenous pacemakers, implantable cardioverter‐defibrillators, and cardiac resynchronization therapy defibrillators is an important complication associated with generator‐replacement procedures. We sought to estimate the incidence and costs associated with transvenous lead damage following cardiac implantable electronic device replacement. METHODS AND RESULTS: Using the Truven Health Analytics MarketScan Commercial Research Database, we identified health care claims between 2009 and 2013 for lead damage following generator replacement. Patients were identified by claims with a procedure code for cardiac implantable electronic device replacement and then evaluated for 1 year. All follow‐up visits for lead damage were identified, and incidence, risk factors, and hospitalization costs were determined. A total of 22 557 patients with pacemakers, 20 632 with implantable cardioverter‐defibrillators, and 2063 with cardiac resynchronization therapy defibrillators met selection criteria. Incidence of lead damage was 0.46% for pacemaker replacement, 1.27% for implantable cardioverter‐defibrillator replacement, and 1.94% for cardiac resynchronization therapy defibrillator replacement procedures (P<0.001). After adjusting for patient characteristics, patients with implantable cardioverter‐defibrillators and cardiac resynchronization therapy defibrillators demonstrated risk of lead damage that was, respectively, double (hazard ratio 2.00, 95% CI 1.57–2.55) and >2.5 times (hazard ratio 2.58, 95% CI 1.73–3.83) that of patients with pacemakers. Lead revision or repair procedures were associated with increased inpatient hospitalization costs (mean $19 959 for pacemaker, $24 885 for implantable cardioverter‐defibrillator, and $46 229 for cardiac resynchronization therapy defibrillator; P=0.048, Kruskal–Wallis test). CONCLUSIONS: These findings establish the first objective assessment of the incidence, risk factors, and economic burden of lead damage following cardiac implantable electronic device replacement in the United States. New care algorithms are warranted to avoid these events, which impose substantial burdens on patients, physicians, and payors. John Wiley and Sons Inc. 2016-02-12 /pmc/articles/PMC4802471/ /pubmed/26873688 http://dx.doi.org/10.1161/JAHA.115.002813 Text en © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Nichols, Christine I.
Vose, Joshua G.
Mittal, Suneet
Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure
title Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure
title_full Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure
title_fullStr Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure
title_full_unstemmed Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure
title_short Incidence and Costs Related to Lead Damage Occurring Within the First Year After a Cardiac Implantable Electronic Device Replacement Procedure
title_sort incidence and costs related to lead damage occurring within the first year after a cardiac implantable electronic device replacement procedure
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802471/
https://www.ncbi.nlm.nih.gov/pubmed/26873688
http://dx.doi.org/10.1161/JAHA.115.002813
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