Differences Between Access to Follow-Up Care and Inappropriate Shocks Based on Insurance Status of Implantable Cardioverter Defibrillator Recipients

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• 作者：Solomon J. Sager ; MD^a ; Chris Healy ; MD^b ; Archana Ramireddy ; MD^b ; Harold Rivner ; MD^b ; Juan F. Viles Gonzalez ; MD^b ; James O. Coffey ; MD^b ; Natalia Rossin ; MSN ; ARNP^b ; Ka M. Lo ; MPH^c ; Jeffrey J. Goldberger ; MD^b ; Robert J. Myerburg ; MD^b ; Raul D. Mitrani ; MD^b ; ^{rmitrani@med.miami.edu}
• 刊名：The American Journal of Cardiology
• 出版年：2017
• 出版时间：15 February 2017
• 年：2017
• 卷：119
• 期：4
• 页码：594-598
• 全文大小：862 K
• 卷排序：119

文摘

Differences in implantable cardioverter defibrillator (ICD) utilization based on insurance status have been described, but little is known about postimplant follow-up patterns associated with insurance status and outcomes. We collected demographic, clinical, and device data from 119 consecutive patients presenting with ICD shocks. Insurance status was classified as uninsured/Medicaid (uninsured) or private/Health Maintenance Organization /Medicare (insured). Shock frequencies were analyzed before and after a uniform follow-up pattern was implemented regardless of insurance profile. Uninsured patients were more likely to present with an inappropriate shock (63% vs 40%, p = 0.01), and they were more likely to present with atrial fibrillation (AF) as the shock trigger (37% vs 19%, p = 0.04). Uninsured patients had a longer interval between previous physician contact and index ICD shock (147 ± 167 vs 83 ± 124 days, p = 0.04). Patients were followed for a mean of 521 ± 458 days after being enrolled in a uniform follow-up protocol, and there were no differences in the rate of recurrent shocks based on insurance status. In conclusion, among patients presenting with an ICD shock, underinsured/uninsured patients had significantly longer intervals since previous physician contact and were more likely to present with inappropriate shocks and AF, compared to those with private/Medicare coverage. After the index shock, both groups were followed uniformly, and the differences in rates of inappropriate shocks were mitigated. This observation confirms the importance of regular postimplant follow-up as part of the overall ICD management standard.