Same-Day Discharge after ICD Placement Shown to be Safe
With appropriate follow-up, eligible patients released the same day do just as well as those kept overnight.
Although the majority of patients receiving implantable cardioverter defibrillators (ICDs) typically spend the night in the hospital, a new piece published in the Journal of the American College of Cardiology is challenging that long-time practice.
Results from the study indicated that patients 65 or older deemed eligible by their physician did just as well when discharged the same day as those who stayed overnight. The findings showed no difference in the two groups in terms of key outcomes, including cumulative incidence of death, all-cause hospital readmission, and readmission related to their ICD device 90 days after discharge.
Using data from the American College of Cardiology’s ICD Registry for implantable cardiovascular defibrillator patients linked with Centers for Medicare and Medicaid Services (CMS) claims data, researchers assessed 58,195 ICD patients from 1,314 hospitals between April 2006 and Dec. 2009. The team found that 3,083 patients (5.3%) were discharged the same day they received an ICD. These patients were under the care of physicians trained in electrophysiology or thoracic surgery less frequently and were more likely to have the procedure done in private practice hospitals than in government facilities or academic centers.
Rates of same-day discharge varied considerably from hospital to hospital, from 0% in 846 hospitals to more than 50% in 27 hospitals. Hospitals discharging ICD patients on the same day were most commonly found in suburban areas and the rate of same-day discharge increased from about 4% in 2006 to more than 6% in 2009.
The study pointed out that for patients who are discharged the same day, it is essential that they receive appropriate follow-up. By performing the procedure early in the day, practitioners would have time to thoroughly examine their patients before discharge, along with educating them about care of the surgical site and arranging outpatient visits.
The study notes that same-day discharge after ICD placement may lead to greater patient satisfaction and cost savings without adversely affecting readmission rates. According to Paul L. Hess, MD, of the Duke Clinical Research Institute and the study’s lead author, “Our data indicate that same-day discharge can be implemented in select patients.”
Questions for You to Consider
- What is an implantable cardioverter defibrillator (ICD)?
- An ICD is a device that uses electrical pulses or shocks to help patients with an irregular heartbeat maintain normal heart rhythm. Upon detecting an abnormal heart rhythm, ICDs send shocks to the heart to help restore normal rhythm and prevent sudden cardiac death.
- Who needs an ICD?
- Implantable cardioverter-defibrillators are used to help prevent sudden cardiac death, which occurs when the heart suddenly stops beating. Most patients with ICDs have a history of sudden cardiac arrest or have been diagnosed with a rapid heartbeat, called ventricular tachycardia. However, ICDs may also be considered for patients at high risk for sudden cardiac death.