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

Autor: Ka M. Lo, Juan F Viles Gonzalez, Natalia Rossin, Chris Healy, James O. Coffey, Raul D. Mitrani, Solomon J. Sager, Harold Rivner, Jeffrey J. Goldberger, Robert J. Myerburg, Archana Ramireddy
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Electric Countershock
Aftercare
030204 cardiovascular system & hematology
Medicare
Health Services Accessibility
Insurance Coverage
03 medical and health sciences
0302 clinical medicine
Internal medicine
Atrial Fibrillation
medicine
Humans
Prospective Studies
030212 general & internal medicine
Intensive care medicine
Physician contact
Aged
Medically Uninsured
Insurance
Health
Medicaid
business.industry
Health Maintenance Organizations
Arrhythmias
Cardiac
Atrial fibrillation
Middle Aged
medicine.disease
Implantable cardioverter-defibrillator
United States
Underinsured
Follow up care
Defibrillators
Implantable
Death
Sudden
Cardiac
Insurance status
Shock (circulatory)
Ventricular Fibrillation
Emergency medicine
Tachycardia
Ventricular
Cardiology
Equipment Failure
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Zdroj: The American Journal of Cardiology. 119:594-598
ISSN: 0002-9149
DOI: 10.1016/j.amjcard.2016.11.007
Popis: 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.
Databáze: OpenAIRE
Externí odkaz: