Implantable Defibrillators: Proper Programing Reduces Hospitalizations and Costs

Maurizio Gasparini, MDMedicalResearch Interview with:
Maurizio Gasparini MD
Humanitas Research Hospital
Rozzano, Italy

Medical Research: What are the main findings of the study?

Dr. Gasparini: We found that a strategic programming of implantable cardioverter defibrillators which allows the non-sustained arrhythmias to self-terminate is associated with reductions in hospitalizations, length of hospital stay and cost per patient-year and an increase in the time to first hospitalization. These results were mainly driven by reduction in cardiovascular-related events.

Medical Research: Were any of the findings unexpected?

Dr. Gasparini: Not entirely.  Previous study already showed that a programming with a prolonged detection of ventricular arrhythmias was associated with a reduction in hospitalizations.  Nevertheless, our data expand what was anticipated in the first  ADVANCEIII trial publication which described a more comprehensive cohort of patients. Finally our findings provide a further perspective including also results on the economic savings, whose importance is constantly increasing, given the current budget constraints that the health care system is experiencing.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gasparini: Our findings show the importance of an appropriate device programming both for the patients, clinicians and for the health care system. The programming strategy comes without additional costs for the hospitals and patients and without requiring extra time for clinicians. Therefore we believe that this approach should be considered as the first choice in ICD programming. Moreover, manufactures should consider updating the settings implemented as nominal in their devices to ensure adoption.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gasparini: The follow up of the ADVANCEIII trial was limited to 1 year. An extended observational period may provide further information on the long-term outcome of these patients.