Nav: Home

Needless shocks from heart devices can trigger extra health costs, Stanford researcher say

February 14, 2017

A team led by a Stanford University School of Medicine researcher has discovered that shocks from implantable cardioverter defibrillators often trigger a cascade of health tests and interventions, even when the shocks they deliver are not needed.

A study describing the team's findings will be published online Feb. 14 in Circulation: Cardiovascular Quality and Outcomes. The lead author is Mintu Turakhia, MD, assistant professor of cardiovascular medicine at Stanford.

Each month, more than 10,000 people in the United States with heart conditions get ICD implants. The devices are designed to keep track of heart rate, delivering an electric shock to control life-threatening rapid rhythms, especially those that can cause sudden cardiac arrest. Sometimes, however, the devices can deliver shocks that are unnecessary. In either case, the patients are expected to see their doctors for an evaluation afterward.

The study analyzed data from patients who were implanted with ICDs between 2008 and 2010. The health care costs of dealing with shocks from ICDs ranged between about $1,300 and $20,000 per patient for outpatient and inpatient care, regardless of whether the shocks were necessary, the team reports.

Unnecessary shocks can occur if there is a problem with the defibrillator system itself -- for example, if a wire breaks, resulting in electrical noise that the system mistakes for an abnormal heart rhythm, or if the implant responds to abnormal heart rhythms that it's not meant to treat.

"Sometimes the defibrillator gets tricked, and it misinterprets what the rhythm is," said Matthew Reynolds, MD, a study co-author and cardiac electrophysiologist at the Lahey Hospital and Medical Center in Massachusetts.

"You're putting these in to do their job to save patients' lives," said Turakhia, who is also the senior director of research at the Stanford Center for Digital Health and a practicing cardiac electrophysiologist. "But we live in a bit of duality with implantable defibrillators."

A cascade of health care use

Interested in trying to understand that contradiction, Turakhia and his colleagues began by tackling the challenge of linking implant data with electronic health records for 10,266 U.S. patients. The team took a freestanding data set of remote monitoring of ICDs and pacemakers and linked it to the patients' clinical information, making it one of the first and largest such studies of its kind, Turakhia said.

"That's one of the big innovations here, especially as we start thinking about big data and precision health," Turakhia said. "Linking data across multiple domains -- indirectly and without patient identifiers -- is the wave of the future to understand disease, care and outcomes."

In the linked data, the team picked 963 patients who had received an ICD shock more than once. They found that over one-third of administered shocks were inappropriate and nearly half the patients who experienced a shock received some form of health care related to it.

But researchers were surprised to find that patients who got a shock were hospitalized one out of seven times. Patients often had to go through procedures like stress tests, cardiac catheterization and echocardiography. "It didn't really matter why the shock occurred," Turakhia said. "The very fact that any shock happened at all triggered all that stuff happening to the patient."

These findings indicate that reprogramming the devices so they are smarter and more selective about when to send shocks may help further reduce health care expenditures. At the same time, patients do better if doctors program the ICDs to shock less, or more conservatively, previous studies suggest. "Fortunately, the industry has made many advancements in this area," Turakhia said. "Even older-generation devices can be programmed to be smarter. The quality of care is no longer just an issue of whether an ICD was implanted in appropriate patients but also whether it was programmed in the best way possible."

The study was done in patients with ICDs implanted between 2008 and 2010, but because arrhythmia treatment practices have changed since that time, including more recent data might have affected the results of the study, Reynolds said. Further, he said it would be interesting to analyze this in a wider cohort of patients, because patients in the present study were all using defibrillators from a single manufacturer, Medtronic Inc.

Looking ahead, Turakhia hopes to use data from remote monitoring devices like defibrillators, as well as insurance claims and electronic health records and even smartphone, genetic and environmental data to take a precision health approach to predicting patient health.

"Right now, we're using very limited data relative to what's out there," he said. But by linking all of that data together, it may be possible to predict, for example, the risk of stroke in patients with certain types of arrhythmia, like atrial fibrillation. In addition, with that data, doctors could potentially predict the chance of someone getting admitted to the hospital with heart failure or the prospect of a patient getting a shock over the next month or so. And having that foreknowledge could help doctors intervene with drugs to better manage risks and save lives, Turakhia said.
-end-
<

Researchers at Hartford Hospital and Medtronic are also co-authors.

Turakhia is a consultant to Medtronic and St. Jude Medical Inc. and has received honoraria for speaking for St. Jude Medical; Reynolds is a consultant to Medtronic.

The research was funded by Medtronic.

Stanford's Department of Medicine also supported the work.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://med.stanford.edu/school.html. The medical school is part of Stanford Medicine, which includes Stanford Health Care and Lucile Packard Children's Hospital Stanford. For information about all three, please visit http://med.stanford.edu.

Stanford University Medical Center

Related Health Care Articles:

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.
International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.
The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .
Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.
High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.
Health insurance changes, access to care by patients' mental health status
A research letter published by JAMA Psychiatry examined access to care before the Patient Protection and Affordable Care Act (ACA) and after the ACA for patients grouped by mental health status using a scale to assess mental illness in epidemiologic studies.
Medical expenditures rise in most categories except primary care physicians and home health care
This article was published in the July/August 2017 issue of Annals of Family Medicine research journal.
Care management program reduced health care costs in Partners Pioneer ACO
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
Health care leaders predict patients will lose under President Trump's health care plans
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
The Lancet: The weaponisation of health care: Using people's need for health care as a weapon of war over six years of Syrian conflict
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
More Health Care News and Health Care Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.