Unnecessary Heart Shocks Trigger Health Costs, Study Finds

For patients with heart disease, an implantable cardioverter defibrillator (ICD) can give a life-saving shock when it senses ventricular arrhythmia. However, unnecessary shocks—essentially, false alarms—can still trigger health costs that would best be prevented.

A study published this week in Circulation: Cardiovascular Quality and Outcomes found that the cost an unnecessary shock averaged $4470 per incident, compared with the average cost of $5592 for appropriate shocks, or those that were found to be necessary. The journal is an official publication of the American Heart Association.

Fortunately, researchers led by Mintu Turakhia, MD, MAS, of the Center for Digital Health at Stanford, say there’s a solution: ICDs, even older models, can be reprogrammed to deliver fewer false alarms, by waiting momentarily to see if ventricular arrhythmia resolves or avoiding shocks that are sent for unrelated causes.

Quality of care, Turakhia said, can no longer be measured only in terms of whether the right patients receive an ICD. The device must be programmed to trigger shocks only when necessary. “We have the technology to do that today,” he said in a statement.

Researchers developed their cost figures by analyzing records from 10,266 patients implanted with a Medtronic ICD in the United States from 2008 to 2010. Medtronic, which funded the study, provided data to be examined alongside patient health records. During the study period, 963 patients experienced 1885 shocks.

While the average age of the patients was 61, the oldest was 81, and 41% had Medicare coverage, which means the findings have implications for taxpayers as well. Of the group, 43% had appropriate shocks, 42% had inappropriate shocks, and 12% had both types.

The study also found:

• About half (46%) of those who received a shock were treated.
• 1 in 3 received emergency department or outpatient care
• Hospitals admitted 1 in 7 of the patients

Patients who turned out to have an unnecessary shock often received costly, invasive procedures, including cardiac catherization.

What causes unnecessary shocks? Turakhia explained that the device cannot examine a patient the way a doctor can, and older programming techniques can mistake a different heart rhythm for ventricular arrhythmia.

The current study was designed only to show whether patients received appropriate shocks, not whether the care received afterward was appropriate. But given the high cost of care from shocks regardless of whether they were needed, Turakhia said it’s safe to say eliminating the false alarms would spare patients unnecessary procedures and expense.

“Optimal device programming that reduces shock events (is) likely to decrease health care costs and improve patient health,” he said.

Reference

Turakhia MP, Zweibel S, Swain AL, Mollenkopf SA, Reynolds MR. Healthcare utilization and expenditures associated with appropriate and inappropriate implantable defibrillator shocks. Circ Cardiovasc Qual Outcomes. 2017; 10:e002210.