Original article Hospital readmission in patients with implantable cardioverter-defibrillators

Abstract

Introduction:
Hospital readmissions are one of the important problems of patients with implantable cardioverter-defibrillators (ICD). Detailed analysis of the causes of rehospitalisations may lead to improved management of ICD patients and eventually limit the number of hospital readmissions.
Aim:
Prospective analysis of repeat hospitalisations, their causes and time from discharge to first hospital readmission in a group of patients after ICD implantation. A search for predictors of rehospitalisation was also performed.
Methods:
Analysis involved 133 consecutive patients who underwent ICD implantation in the Department of Cardiology, PAM. Readmission causes were split into cardiac and non-cardiac. An index of repeat hospitalisation was calculated and parameters with a direct impact on rehospitalisation necessity were also evaluated. Results: One hundred and sixty-seven hospital readmissions of 72 (54%) patients were noted at mean 22±15 months after the primary hospitalisation. Rehospitalisation index per patient for the total follow-up period was 1.26, while for the first year of follow-up it was 0.69. In the case of 42 (32%) patients, 91 (54.5%) hospital readmissions were associated with arrhythmia. In 34 (25.6%) patients, 54 (32.3%) rehospitalisations were not related to arrhythmia, while 20 (15%) patients were hospitalised 22 times (13.2%) for non-cardiac reasons. Mean time to the first readmission, regardless of the reason, was 9±9 months. Predominant causes of repeat hospitalisation were ventricular arrhythmias and worsening of heart failure. Patients with left ventricular ejection fraction (LVEF) below 30% and in functional NYHA class III were readmitted to hospital more frequently for reasons not related to arrhythmia.
Conclusions:
Hospital readmissions for cardiac causes in patients after ICD implantation are still frequent. Most of them are caused by ventricular arrhythmia and heart failure. Low LVEF (<30%) and NYHA functional class ≥III are risk factors predicting repeat hospitalisations unrelated to arrhythmia.