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Same-Day Discharge After ICD Placement | Journal Scan
Study Questions:
Is the rate of complication following implantation of an implantable cardioverter-defibrillator (ICD) different among patients who are discharged on the same day as the procedure, as compared to those observed overnight?
Methods:
The medical records of patients enrolled in the National Cardiovascular Data Registry for ICDs were reviewed. Inclusion criteria included age ≥65 years, and those patients with a primary prevention indication. Exclusion criteria included patients with a pre-existing ICD (i.e., those presenting for a generator change), sustained ventricular arrhythmias, class IV symptoms, who died during the hospitalization, who were admitted for a non–ICD-related indication, were discharged to a facility other than their home, and those whose length-of-stay was >1 day.
Results:
The study group consisted of 58,195 patients, recruited from 1,314 institutions, over approximately 3.5 years. A total of 3,083 patients were discharged on the same day, as compared to 55,112 patients who were discharged after overnight observation. After adjusting for various confounders, there were no significant differences in the rates of death, all-cause readmission, and device-related readmission at 90 days. However, patients discharged on the same day were more likely to have been readmitted for any reason at 7 days (hazard ratio, 1.3, 95% confidence interval, 1.1-1.7; p = 0.02).
Conclusions:
The authors concluded that select patients undergoing ICD implantation might be candidates for same-day discharge.
Perspective:
Patients undergoing ICD implantation are routinely monitored overnight for complications (occurring in about 2-3% of patients, including pneumothorax, venous thrombosis, bleeding, cardiac perforation, lead dislodgement/mechanical dysfunction, and rarely infection) and pain. There is probably a subset of patients who may be safely discharged on the day of the procedure, including those receiving a subcutaneous (cf. transvenous) device. Remote monitoring (to confirm lead/device integrity) on the day following discharge may also play a role. Patients on dual antiplatelet or anticoagulant therapy, those with rapid rates during atrial fibrillation or frequent episodes of ventricular arrhythmias, and those with borderline hemodynamics at baseline should continue to be monitored overnight or as clinical context dictates.
Keywords: Arrhythmias, Cardiac, Defibrillators, Implantable, Heart Conduction System, Patient Discharge, Patient Readmission, Primary Prevention, National Cardiovascular Data Registries, Medical Records, Hospitalization
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