Heart Device Follow-Up Still Low

Cardiovascular implantable electronic device follow-up improving but still lags

(RxWiki News) Follow-up care after an implanted heart device, such as a pacemaker, is recommended for optimal care. Though the number receiving follow-up appointments is low, research shows significant strides have been made in recent years.

In 2005, about 40 percent of individuals with implanted heart devices received an initial follow-up appointment, while that number jumped to 55 percent in 2009, a new study has revealed.

White patients were significantly more likely to receive an in-person visit two to 12 weeks after implantation, as compared to individuals of other races.

"Schedule a physician follow-up after any procedure."

Sana M. Al-Khatib, MD, MHS, a lead author from Duke Clinical Research Center, initiated the research to determine how many patients were receiving standard follow-up care after implantation of a heart device. In determining whether patients received appropriate follow-up, Dr. Al-Khatib examined whether patients received the follow-up care outlined in a 2008 expert consensus statement outlining minimum follow-up for patients with cardiovascular implantable electronic devices (CIEDs).

CIEDs include a broad category of implanted heart devices designed to treat patients with an abnormal heart rhythm. Such devices include pacemakers, implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT).

ICDs are implantable devices that provide a shock to restore heart rhythm in patients with a heart arrhythmia that puts them at risk of sudden cardiac death. CRT features a pulse generator that treats a delay in heart ventricle contractions in patients with advanced heart failure. Pacemakers provide electrical impulses to maintain a regular heart rhythm.

During the cohort study, researchers reviewed a 5 percent sample of Medicare claims data, including 38,055 patients between January 2005 and June 2009. All of the patients were over the age of 66. Of the patients who received a heart device, about 88 percent were white.

Of the participants, 33,206 received atrial pacemakers, 33,207 were implanted with ventricular pacemakers, 33,208 received dual-chamber pacemakers, and 33,249 received ICDs. Researchers identified 33,225 who received a CRT device by identifying a code for insertion of a left ventricular lead, or the wires that send electrical impulses that cause the heart to contract.

Overall 43 percent of patients had an in-person follow-up visit between two and 12 weeks after implantation, though that increased to 65 percent when the timeframe was extended to 16 weeks. But a positive trend was seen in improvement over the study period, with a follow-up rate of 40 percent in 2005 compared to 55 percent in 2009.

ICD patients were slightly more likely to receive a follow-up visit, with 44 percent reporting for an initial visit versus 42 percent of pacemaker patients. Younger patients between the ages of 65 and 79 were also slightly more likely to receive a follow-up visit as compared to patients over age 80.

White patients were 43 percent more likely to receive a follow-up visit as compared to patients of another race. The majority of the patients followed in the study were white.

A larger improvement was seen in ICD follow-ups. In 2005, 41 percent of ICD recipients received a follow-up visit compared to 59 percent in 2009. The number of follow-ups for pacemaker patients increased from 40 percent to 54 percent.

An additional 72 percent of ICD patients received a follow-up visit within three to six months of their initial visit, while 93 percent of pacemaker patients followed up within three to 12 months of initial appointment. Researchers were surprised by this finding since ICDs are more complex than pacemakers.

Over the period of the study, the average number of days to first follow-up visit also decreased from 42 days to 37. About 78 percent of all patients had received a follow-up visit at the one-year mark.

Researchers encouraged additional research into why some patients do not receive follow-up visits. They also suggested development of a quality improvement program aimed at enhancing follow-up care of CIED patients.

A coauthor of the research was paid for editing a book about pacemakers and ICDs. Three additional research authors received grants or consulting payments from medical device manufacturer Boston Scientific, or drug makers including GlaxoSmithKline and Johnson & Johnson.

The study, funded by the National Heart, Lung, and Blood Institute, was recently published in Circulation: Arrhythmia and Electrophysiology, an American Heart Association journal.

Review Date: 
January 3, 2013