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. 2018 Apr;51(3):221-228.
doi: 10.1007/s10840-018-0336-0. Epub 2018 Feb 28.

Increased healthcare utilization associated with complete atrioventricular block in pacemaker patients

Suneet Mittal  1   2 , Dan L Musat  3 , Michael H Hoskins  4 , Julie B Prillinger  5 , Gregory J Roberts  5 , Yelena Nabutovsky  5 , Faisal M Merchant  4
Affiliations

Increased healthcare utilization associated with complete atrioventricular block in pacemaker patients

Suneet Mittal et al. J Interv Card Electrophysiol. 2018 Apr.

Abstract

Purpose: The purpose of the current study is to characterize and quantify the impact of complete atrioventricular block (cAVB) on heart failure hospitalization (HFH) and healthcare utilization in pacemaker (PM) patients.

Methods: Patients ≥ 18 years implanted with a dual-chamber PM from April 2008 to March 2014 were selected from the MarketScan® Commercial and Medicare Supplemental claims databases. Patients with ≤ 1-year continuous MarketScan enrollment prior to and post-implant, and those with prior HF diagnosis were excluded. Patients were dichotomized into those with cAVB, defined as a 3rd degree AVB diagnosis or AV node ablation in the year prior to PM implant, versus those without any AVB (noAVB). Post-implant HFH and associated costs were compared based on inpatient claims.

Results: The study cohort included 21,202 patients, of which 14,208 had no AVB and 6994 had cAVB, followed for 2.39 and 2.27 years, respectively. Patients with cAVB were associated with a significantly increased risk of cumulative HFH (HR 1.59 [95% CI 1.35-1.86] p < 0.001) and significantly higher costs ($636 [609-697] vs $369 [353-405] per pt-year, p < 0.001) compared to those with no AVB.

Conclusions: Among dual-chamber PM patients without prior HF, cAVB is associated with a significantly increased risk of HFH and greater HF-related healthcare utilization. Identifying patients at high risk for HF in the setting of RV pacing, and potentially earlier use of biventricular or selective conduction system pacing, may reduce HF-related healthcare utilization.

Keywords: Atrioventricular block; Healthcare utilization; Heart failure; Pacemakers; Right ventricular pacing.

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Conflict of interest statement

SM: Consulting fees from Abbott.

DLM: None.

MHH: Consulting fees from Abbott.

JBP: Stock Medtronic, Inc., stock and salary from Abbott.

GJR: Stock and salary from Abbott.

YN: Stock and salary from Abbott.

FMM: None.

Figures

Fig. 1
Fig. 1
Cohort diagram. Schematic of patients included in the study cohort, including those with no atrioventricular block (noAVB) and those with complete atrioventricular block (cAVB). All patients had a de novo dual chamber pacemaker implant between April 1, 2008, and March 31, 2014, and did not have a clinical diagnosis of heart failure in the 1 year prior to implant
Fig. 2
Fig. 2
Cumulative risk of heart failure hospitalization following pacemaker implant. Heart failure hospitalizations (HFHs) following pacemaker implant in patients with cAVB versus noAVB. Propensity score adjusted for age, sex, remote monitoring status, US region, year of implant, and 20 baseline comorbidities assessed in the year prior to implant. cAVB complete atrioventricular block, CI confidence interval, HFH heart failure hospitalization, HR hazard ratio, noAVB no atrioventricular block
Fig. 3
Fig. 3
Distribution of number of heart failure hospitalizations following pacemaker implant. Cumulative number of HFH following pacemaker implant in the noAVB and cAVB groups. cAVB complete atrioventricular block, HFH heart failure hospitalization, noAVB no atrioventricular block
Fig. 4
Fig. 4
Annual adjusted heart failure hospitalizations payments following pacemaker implant. Results of a two-part model showing the predicted annual payments associated with HFH for patients with noAVB and cAVB. cAVB complete atrioventricular block, HFH heart failure hospitalization, noAVB no atrioventricular block
See this image and copyright information in PMC

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