AN EVALUATION OF CARDIAC PROCEDURES AFTER USE OF A WEARABLE CARDIOVERTER DEFIBRILLATOR

Purpose:

The implantable cardioverter-defibrillator (ICD) has been shown to improve survival from sudden cardiac arrest and to improve overall survival in several populations at high risk for sudden cardiac death. However, there remain situations in which implantation of an ICD may be inappropriate or delayed, and a wearable cardioverter-defibrillator (WCD) may be an acceptable alternative approach for the prevention of sudden cardiac death. The purpose of this analysis was to describe utilization of WCD and subsequent cardiac procedures in clinical practice.

 

Methods:

Patients who used a WCD were identified using retrospective claims from the Humana Database (January 2011- April 2013). Patients were followed for the duration of WCD use, and use of an ICD within 60 days of WCD discontinuation was reported. Cardiac diagnostic and interventional procedures during the 240 days post-WCD were also reported.

 Results:

Utilization of WCDs was low in this population, but increased 2-fold year over year during the evaluation period.  A total of 1,199 patients used WCDs between 2011 and 2013 with a mean duration of use of 2.4 months (95% confidence interval 2.33 – 2.5).  The top diagnoses for which the WCDs were prescribed included non-ischemic primary cardiomyopathies, acute myocardial infarction (MI), and old MI collectively representing 78% of the total.  Sixty-two percent (n=746) of WCD users did not get an ICD within 60 days. Forty-seven percent (n=567) of WCD users did not have any additional targeted cardiac procedures.  Of those who did have a procedure (53%, n=632), cardiac nuclear medicine and cardiac catheterization represented the majority of all post-WCD diagnostic procedures (44%) and ICDs made up the largest group of interventional procedures (27%).

 

Conclusion:

WCD is intended as a temporary solution with the main indications being a bridge to ICD implantation or until the arrhythmic substrate subsides.  In this analysis, we found that the majority of WCD users did not got on to have an ICD, and nearly half had no additional targeted cardiac procedure.  These data from clinical practice may help to determine the role of WCD in cardiac therapy.