PO06-23: Medtronic carelink express device usage in midsize emergency department

Introduction: Patients with Medtronic devices presenting to emergency department (ED) need interrogation of the device. The manual interrogation via the on-call nurse or the representative may take time. This time will increase the cost per case and the overflow in the ED preventing newcomers to be seen in a timely fashion. CareLink express (CLE) technology allows an automatic interrogation in the ED that will be interpreted instantly electronically. The time and cost using CLE is evaluated in a midsize ED. Methods: During a 10-month period there were 125 consecutive patients with Medtronic devices (69.5± 20 years old, 61.3% males) who came to ED for interrogation. The cost and length of stay in ED was compared between two groups. The study group includes patients with CLE (46 patients); the control group includes patients without CLE (79 patients). Endpoints measured were length of stay in ED in minutes and estimated cost of stay ($6/min cost factor is used according to National Database of Hospitals 2010). Results: The demographics of the two groups were similar (67.9±2.48 vs. 70.3±1.83 years old; and 67.4$1093.4±58.14) vs. the control group ($1378.7±55.16) (P=0.001). There was no difference in the interrogation findings (76.1% vs. 64.6% normal) and defibrilator shocks (10.9% vs. 8.9%). The inpatient admission decision was the same in both groups (43.5% vs. 53.2%). As expected, there was a trend of fewer patients in the CLE group that had reprogramming of the device (2.2% vs. 13.9%) (P = 0.055). Conclusions: CareLink Express facilitates a shorter length of stay in the ED for patients with Medtronic devices and less cost to the patient without affecting the disposition decision

Medtronic CareLink Express device usage in midsize emergency department

Conclusion: CareLink Express facilitates a shorter length of stay in ED with number of patients needed to make it cost-effective is at least 19 patients per year in facilities without an on-call pacewatch nurse, and 12 patients per year in facilities with an on-call pacewatch nurse

Score Big for Decreasing Mortality: ICD Risk Score Model

Background: Aurora Health Care, a system of 14 acute care hospitals in eastern Wisconsin, has been a long-time participant in the American College of Cardiology’s National Cardiovascular Data Registries, submitting data to its ICD Registry™ since 2005. Our system’s implantable cardioverter-defibrillator (ICD) procedure volume averages 930 cases annually. During 2012 we experienced an increase in in-hospital mortality/morbidity for ICD cases. Purpose: A single-center study examining in-hospital mortality/morbidity post-ICD implant before and after changes in practice and patient selection. Methods: ICD implants and generator changes discharged from January 1, 2009, to December 31, 2012, were included in developing a risk model predicting in-hospital mortality/morbidity. The risk score was shared with physicians for clinical input. A point system was developed, including those factors with highest risk. Using the defined factors, a risk score \u3e 14 was used to indicate those at highest risk for morbidity/mortality. The risk score model was fit on the development group (2009–2012), and then re-run for the intervention cohort from January 1, 2013, to June 30, 2014. Logistic regression was used in the risk model development and validation. Continuous variables were compared using Student’s t-test, and categorical variables were compared using chi-square test. Results: From 2009 to 2012, 3,417 ICD implants and generator changes were performed and included in risk model development. Of those, 200 (5.9%) patients were indicated as high risk with a score \u3e 14. From January 2013 to June 2014, 1,057 implants and generator changes were performed, with 41 (3.4%) patients indicated as high risk with a score \u3e 14. In the development phase, mean age was 67 years and 70% of patients were male. Post-model development, mean age was 66 years with 72% male. For patients indicated as high risk, in-hospital mortality/morbidity dropped from 20 (10%) to 2 (4.9%), though the decrease was not statistically significant (P = 0.39). Conclusion: Awareness of high-risk patients and changes in patient selection can lead to improvement in in-hospital mortality/morbidity among those high-risk patients. Although the improvement was not statistically significant, this was most likely due to low volumes and we will continue to monitor outcomes among these patients

Cost effectiveness of medtronic carelink express device usage in emergency department

BACKGROUND: Patients with Medtronic devices presenting to emergency department (ED) need interrogation of the device. Manual interrogation via on-call personnel may take time, increase direct cost to the patient and increase the overflow in the ED. CareLink Express (CLE) technology allows automatic interrogation in the ED that will be interpreted instantly electronically. OBJECTIVE: Direct cost effectiveness to patients using this new technology was evaluated. METHODS: In 12 months there were 147 consecutive patients with Medtronic devices (61-84 years old, 62.3% males) who came to ED for interrogation. The first 6 months, the patients were interrogated via traditional method (60 patients). The following 6 months, CLE was used (54 patients). Demographics, comorbidities, diagnosis, device findings, admission, reprogramming, length of stay (LOS) in ED, cost and follow-ups were compared between the groups. RESULTS: Demographics were similar between groups. Comorbidities including chronic kidney disease, diabetes, hypertension, dyslipidemia, congestive heart failure, coronary artery disease and history of coronary artery bypass grafting also were similar. There was no difference in diagnosis category. Both groups had similar device interrogation findings (64.5% vs. 72.1% normal, p=0.33). The use of CLE did not affect the decision for hospital admission (45.6% vs. 53.2%, p=0.36), nor rate of reprogramming (7.4% vs. 13.9%, p=0.2). Median follow-up with out-patient cardiology clinic was the same in both groups (23 vs. 33 days, p=0.35). The use of CLE significantly shortened the LOS in ED (185.2±63.1 vs. 229.8±81.7 min, p CONCLUSIONS: CareLink Express facilitates shorter LOS in the ED for patients with Medtronic devices with significant cost effectiveness to the patient without compromising the decision for disposition or follow-up

Vagal response during pulmonary vein isolation with cryoballoon ablation

Background: Vagal nerve response, seen during cryoballoon ablation of the pulmonary veins, can be attributed to the ablation’s effect on the ganglionated plexi. This effect is demonstrated with drops in blood pressure and heart rate during pulmonary vein isolation with cryoballoon ablation. Purpose: To evaluate surrogate markers for vagal response during pulmonary vein isolation with cryoballoon ablation. Methods: A total of 22 patients with paroxysmal atrial fibrillation underwent pulmonary vein isolation with a 28-mm second-generation cryoballoon using a 3-minute freeze technique. Two or more lesions were performed for each vein. Initial blood pressure, nadir blood pressure, time to reach -30 degrees, time to reach -40 degrees, time from start of thaw to reach zero degrees (TT0), time from start of thaw to the nadir blood pressure (TTNBP), total freeze time, minimal temperature reached, and time from start of freeze to vein isolation by electrogram were recorded. Clustered data for each vein were analyzed using the common slope and linear intercept mixed model. Results: All patients (mean age: 62.5 ± 8.4 years; male sex: 69%, body mass index: 31.7 ± 5.7; mean CHA2 DS2 -VASc score: 1.8 ± 1.2; white race: 100%; hypertension: 56%; coronary artery disease: 38%; sleep apnea: 50%; mean left atrial volume index: 58.6 ± 17.8 ml/m2 ; left ventricular ejection fraction of ≥55: 100%) had paroxysmal atrial fibrillation. Univariate analysis demonstrated that the best surrogate marker for vagal response was the TT0 in the inferior veins. The drop in blood pressure increased up to fourfold, with a onefold increase in thawing duration (TT0 in left inferior vein: 3.040, P Conclusion: Vagal response during cryoballoon ablation was seen mainly during isolation of the inferior pulmonary veins

Endovascular stent graft repair of abdominal aortic aneurysms in high-risk patients: a single center experience

BACKGROUND: Endovascular stent graft (EVG) repair can be a safe alternative to open surgical repair to treat abdominal aortic aneurysms (AAA) in high-risk patients. We report our results with EVG repair in such high-risk patients at our institution. OBJECTIVES: We wanted to show that EVG repair can be performed successfully and with a low complication rate in patients with serious comorbidities. METHODS: All patients prospectively studied underwent EVG repair of AAA from February 2000 to July 2002. RESULTS: Of the 60 patients studied, 45 (75%) were high-risk surgical candidates because of associated comorbidities; their aneurysms ranged from 4.5 to 10 cm (mean: 5.7 +/- 1.2 cm). Fifty-nine of 60 patients (98.3%) were treated successfully. Two (3.3%) who underwent surgical intervention for site-related complications died from postoperative complications. Hospital stay was(77%) patients. CONCLUSION: Our preliminary results show that EVG is safe, feasible, and yields excellent technical success even in patients at high risk for complications. Teamwork between interventional cardiologists and vascular surgeons is advised

Lead Burden as a Factor for Higher Complication Rate in Patients With Implantable Cardiac Devices

Purpose Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads. Methods We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 [n=168]; Group C: ≥5 [n=16]). Prespecified inhospital and long-term follow-up events were compared. Mortality rates were obtained from Social Security Death Index. Median follow-up was 2 years. Results Baseline age, gender and race demographics were similar among the three groups. Increasing lead burden was associated with more adverse periprocedural events (A: 3.4%, B: 10.1%, C: 25.0%; P=0.031) and long-term device-related events (A: 1.7%, B: 13.0%, C: 18.8%; P=0.031). Device-related readmissions increased in frequency as lead burden increased (A: 3.5%, B: 18.5%, C: 37.5%; P=0.002). Combined periprocedural and late events also increased with more redundant leads (A: 5.2%, B: 23.2%, C: 44.0%; P=0.001). Total major events were infrequent (3.3%). There was no procedure-related mortality. Long-term all-cause mortality was not significantly different (A: 17.2%, B: 23.8%, C: 25.0%; P=0.567). Conclusions Greater lead burden was associated with increased number of periprocedural and long-term minor events. It did not significantly impact major events or mortality