What are the professional and logistic demands to appropriately follow patients with an implantable cardioverter-defibrillator?

Abstract

OBJECTIVES: To determine events during follow-up of patients with implantable cardioverter-defibrillators (ICD) and the specific experience cardiologists need for trouble-shooting. DESIGN: Prospective evaluation of all patient visits in an outpatient clinic. SETTING: University hospital, single centre performing ICD controls in a region of 1.5 Mio inhabitants. SUBJECTS: A total of 351 patients with 1118 consecutive visits during 14 months. INTERVENTIONS: Classification of events according to predefined training levels. MAIN OUTCOME MEASUREMENTS: Skill levels A: simple visit, e.g. for switching the device 'off'. B: normal visit, no further measures taken (no device reprogramming), even though the patient might have experienced ICD interventions. C: complex visit, electrophysiologist actively involved. Correlation of these levels with timing (routine, emergency on/off office hours) and reason of visits. RESULTS: Seventy-six per cent of visits were scheduled routine visits, 5% performed within 24 h because of shocks, 19% performed for other reasons (shock tests; switching the device 'off/on'; reported dizziness, syncope, palpitations without ICD interventions). Required skill levels were A in 44 (4%), B in 796 (71%) and C in 278 (25%) visits. Emergency visits were more often classified as level C (60%) than regular visits (20%), Skill level C was more often encountered during emergency (30%) than during regular visits (6%) (both P = 0.001). CONCLUSIONS: Our study suggests that for standard follow-up in patients without obvious problems, a cardiologist might be sufficient, whereas presentations due to/with clinical problems most likely will need the expertise of an electrophysiologist.