Advancing on ADVANCE III: ICD interval affects hospitalizations, costs

A programming strategy for implantable cardioverter-defibrillators (ICDs) reduced hospitalizations, length of stay and costs compared with standard care, according to a research letter published in the Aug. 6 issue of JAMA.

In a follow-up to the ADVANCE III (Avoid Delivering Therapies for Non-sustained Arrhythmias in ICD Patients III) trial, Alessandro Proclemer, MD, of Azienda Ospedaliera Universitaria S. Maria della Misericordia in Udine, Italy, and colleagues reviewed the previously reported data to determine whether a long-detection interval approach affected hospitalization rates, length of stay and costs.

They found that when ICDs were programmed to detect arrhythmias at an interval rate of 30 to 40 intervals (long detection) as opposed to a standard of 18 to 24 intervals, physicians had a more detailed understanding of what was happening with a patient’s overall health.

The rate of overall hospitalizations for patients in the long-detection group was lower than for patients in the standard group, at 43.8 and 52.3 per 100 patient years, respectively. First hospitalizations occurred later in the long-detection interval group, whether overall or for cardiovascular reasons. Proclemer et al also noted a 63 days per patient year reduction in length of stay for patients monitored with long-detection intervals.

No differences were noted in mortality rates.

Due to the reduction in hospitalizations and length of stay, Proclemer et al noted a mean savings of $299 per patient year for overall hospitalizations and $329 per patient year for cardiovascular hospitalizations.

While this review was limited to one year due to available data, the research team suggested that these estimates were favorable in demonstrating effectiveness of long-detection interval strategies to improve healthcare and costs.