Europace Advance Access originally published online on September 3, 2008
Europace 2008 10(11):1288-1295; doi:10.1093/europace/eun240
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Implantable cardioverter-defibrillators
Longevity of implantable cardioverter-defibrillators: implications for clinical practice and health care systems
1 Institute of Cardiology Policlinico S. Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; 2 Department of Pharmacy, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
Aims: Comparative studies on the longevity of implantable cardioverter-defibrillators (ICDs) among different manufacturers have never been reported. Longevity of ICD devices implanted from 1 January 2000 to 31 December 2002 was prospectively investigated according to their type and manufacturer.
Methods and results: Longevity of single-chamber (SC), double-chamber (DC), and biventricular (CRT-D) ICDs from Medtronic (MDT), Guidant (GDT), and St Jude Medical (SJM) was measured in all the patients who required device replacement. The observation follow-up ended on 31 December 2007; patients who died prematurely or were transplanted before battery exhaustion were excluded from the analysis. Factors associated with longevity (number of delivered shocks, pacing activity) were researched. One hundred and fifty-three patients received an ICD in the abovementioned period. Six underwent heart transplantation, and 23 died before device replacement; 80 had an SC device, 59 had DC device, and 14 had CRT-D device. Longevity of MDT was superior to GDT and SJM, replacement rates being, respectively, 42%, 95.3%, and 97.2%. Only MDT manufacturers and SC type were associated with greater ICD longevity. Longevity had an impact on the cost/month of treatment of replaced ICDs.
Conclusion: Battery longevity is significantly different among manufacturers. ICD cost is strictly dependent on device longevity, whereas device up-front cost is of limited clinical meaning. Appropriate assessment of cost-effectiveness should be based on ICD longevity in the real-life scenario.
Key Words: Implantable cardioverter-defibrillator, Battery longevity, Device cost
* Corresponding author. Tel: +39 (0) 51 6363531; fax: +39 (0) 51 344859. E-mail address: mauro.biffi{at}aosp.bo.it
Manuscript submitted 1 June 2008. Accepted after revision 6 August 2008.
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