• Mintu P Turakhia, Steven Zweibel, Andrea L Swain, Sarah A Mollenkopf, and Matthew R Reynolds.
• From the Center for Digital Health, Stanford University School of Medicine, Stanford, CA (M.P.T.); the Division of Cardiac Electrophysiology, Hartford Healthcare Heart and Vascular Institute, Hartford, CT (S.Z.); the Department of Economics, Reimbursement, and Evidence, Medtronic plc, Mounds View, MN (A.L.S., S.A.M.); and Baim Institute for Clinical Research, Boston, MA (M.R.R.). mintu@stanford.edu.
• Circ Cardiovasc Qual. 2017 Feb 1; 10 (2).

BackgroundIn patients with implantable cardioverter-defibrillators, healthcare utilization (HCU) and expenditures related to shocks have not been quantified.Methods And ResultsWe performed a retrospective cohort study of patients with implantable cardioverter-defibrillators identified from commercial and Medicare supplemental claims databases linked to adjudicated shock events from remote monitoring data. A shock event was defined as ≥1 spontaneous shocks delivered by an implanted device. Shock-related HCU was ascertained from inpatient and outpatient claims within 7 days following a shock event. Shock events were adjudicated and classified as inappropriate or appropriate, and HCU and expenditures, stratified by shock type, were quantified. Of 10 266 linked patients, 963 (9.4%) patients (61.3±13.6 years; 81% male) had 1885 shock events (56% appropriate, 38% inappropriate, and 6% indeterminate). Of these events, 867 (46%) had shock-related HCU (14% inpatient and 32% outpatient). After shocks, inpatient cardiovascular procedures were common, including echocardiography (59%), electrophysiology study or ablation (34%), stress testing (16%), and lead revision (11%). Cardiac catheterization was common (71% and 51%), but percutaneous coronary intervention was low (6.5% and 5.0%) after appropriate and inappropriate shocks. Expenditures related to appropriate and inappropriate shocks were not significantly different.ConclusionsAfter implantable cardioverter-defibrillator shock, related HCU was common, with 1 in 3 shock events followed by outpatient HCU and 1 in 7 followed by hospitalization. Use of invasive cardiovascular procedures was substantial, even after inappropriate shocks, which comprised 38% of all shocks. Implantable cardioverter-defibrillator shocks seem to trigger a cascade of health care. Strategies to reduce shocks could result in cost savings.© 2017 American Heart Association, Inc.

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