Room for improvement with in-person follow-up appointments after patients receive cardiac devices

February 28, 2013 – It is unclear why there is a low rate of follow-up appointments, or whether having a follow-up appointment within the recommended timeframe improves patient outcomes.

In 2008, the Heart Rhythm Society and the European Heart Rhythm Association released a consensus statement recommendation about the minimum frequency of in-person or remote follow-up appointments after the implantation of a cardiac device, such as an implantable cardioverter defibrillator (ICD) or pacemaker. Although these types of devices are used routinely, improvements in technology have made them more complex, thus requiring regular monitoring to ensure they are functioning properly and programmed correctly. Early in-person follow-up helps patients avoid infections, bleeding complications, and dislodgement of a device.

The DCRI’s Sana Al-Khatib, MD, MHS, led a study to assess how consistently these recommendations are followed. The results were published in the February issue of Circulation: Arrhythmia and Electrophysiology. Other DCRI authors included Paul Hess, MD, and Lesley Curtis, PhD, who was the senior author.

Researchers analyzed data from more than 38,000 Medicare patients who received an implantable cardiac device between 2005 and 2009. Among patients who were eligible for in-person follow-up appointments, approximately 42 percent attended their appointments within the recommended timeframe of two-to-12 weeks. However, this rate improved by 15 percent by the end of the study.

The study notes that white patients were more likely to have an initial in-person follow-up appointment in the recommended timeframe than patients of other races. Also, patients who were between 65 and 79 years old were more likely to receive a timely in-person follow-up appointment than patients who were 80 years or older.

The study provided some insight into how often patients have follow-up appointments after receiving a cardiac device, but questions remain. It is unclear why there is a low rate of follow-up appointments, or whether having a follow-up appointment within the recommended timeframe improves patient outcomes. Further study is needed to answer these questions.

Based on these study findings, the authors recommend developing quality improvement programs to improve timely follow-up appointments among all races and age groups