AimsDevice replacement at the time of battery depletion of implantable cardioverter-defibrillators (ICDs) may carry a considerable risk of complications and engenders costs for healthcare systems. Therefore, ICD device longevity is extremely important both from a clinical and economic standpoint. Cardiac resynchronization therapy defibrillators (CRT-D) battery longevity is shorter than ICDs. We determined the rate of replacements for battery depletion and we identified possible determinants of early depletion in a series of patients who had undergone implantation of CRT-D devices.Methods and resultsWe retrieved data on 1726 consecutive CRT-D systems implanted from January 2008 to March 2010 in nine centres. Five years after a successful CRT-D implantation procedure, 46% of devices were replaced due to battery depletion. The time to device replacement for battery depletion differed considerably among currently available CRT-D systems from different manufacturers, with rates of batteries still in service at 5 years ranging from 52 to 88% (log-rank test, P < 0.001). Left ventricular lead output and unipolar pacing configuration were independent determinants of early depletion [hazard ratio (HR): 1.96; 95% 95% confidence interval (CI): 1.57–2.46; P < 0.001 and HR: 1.58, 95% CI: 1.25–2.01; P < 0.001, respectively]. The implantation of a recent-generation device (HR: 0.57; 95% CI: 0.45–0.72; P < 0.001), the battery chemistry and the CRT-D manufacturer (HR: 0.64; 95% CI: 0.47–0.89; P = 0.008) were additional factors associated with replacement for battery depletion.ConclusionThe device longevity at 5 years was 54%. High left ventricular lead output and unipolar pacing configuration were associated with early battery depletion, while recent-generation CRT-Ds displayed better longevity. Significant differences emerged among currently available CRT-D systems from different manufacturers.

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AimsPatients receiving cardiac resynchronization therapy defibrillators (CRT-Ds) are likely to undergo one or more device replacements, mainly for battery depletion. We assessed the economic impact of battery depletion on the overall cost of CRT-D treatment from the perspectives of the healthcare system and the hospital. We also compared devices of different generations and from different manufacturers in terms of therapy cost.Methods and resultsWe analysed data on 1792 CRT-Ds implanted in 1399 patients in 9 Italian centres. We calculated the replacement probability and the total therapy cost over 6 years, stratified by device generation and manufacturer. Public tariffs from diagnosis-related groups were used together with device prices and hospitalization costs. Generators were from 3 manufacturers: Boston Scientific (667, 37%), Medtronic (973, 54%), and St Jude Medical (152, 9%). The replacement probability at 6 years was 83 and 68% for earlier- and recent-generation devices, respectively. The need for replacement increased total therapy costs by more than 50% over the initial implantation cost for hospitals and by more than 30% for healthcare system. The improved longevity of recent-generation CRT-Ds reduced the therapy cost by ∼6% in both perspectives. Among recent-generation CRT-Ds, the replacement probability of devices from different manufacturers ranged from 12 to 70%. Consequently, the maximum difference in therapy cost between manufacturers was 40% for hospitals and 19% for the healthcare system.ConclusionsDifferences in CRT-D longevity strongly affect the overall therapy cost. While the use of recent-generation devices has reduced the cost, significant differences exist among currently available systems.

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This new clinical approach, which implies extensive workload, time-spending, and specific knowledge, and in our reality carried by the "good will" of the operators involved, will be in the future recognized and dignified with spaces and time dedicated, and will be recognized as "DRG." Telemedicine is making the difference in this pandemic and maybe it can be more crucial in the future, resulting in a positive synergy between hospitals, patients, and general practice care.

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Ejection fraction (EF) determines eligibility for CRT in heart failure patients (Pts) with left bundle branch block (LBBB). Since EF by echocardiography (Echo) may be hampered by technical difficulties it would be of interest to have an alternative for Pts with LBBB. Previous studies have shown good correlation between EF and systolic time intervals (STI), including pre-ejection period (PEP), left ventricular ejection time (LVET) and the ratio PEP/ LVET, but they were done mostly in Pts with narrow QRS.Objective: Since LBBB alters left ventricular timing, it was our purpose to determine if STI could also predict EF in Pts with LBBB. Methods: Of 134 Pts enrolled in the Latin America CRT Study, 30 Pts with LBBB eligible for CRT were selected using the following criteria: 1. Good quality Doppler aortic flow with simultaneous ECG for PEP and LVET measurements; 2. Echo images of the left ventricle with well-defined endocardium, resulting in reliable EF by independent observers. A Systolic Function Index (SFI), calculated as LVET/PEP, where LVET is the time from onset to end of aortic flow by Doppler, and PEP, from the onset of QRS to the onset of aortic flow. Regressions between EF and SFI were obtained. Results: Of selected 30 Pts, 77% were male, with a mean age of 63 + 12. Mean EF was 21% with a range of 10% to 38%. The R value of SFI and EF was 0.8, with a standard error of the mean of + 4% (P , 0.001) (Fig). Conclusions: EF can be predicted from SFI in Pts with LBBB with low margin of error. Purpose of the study: Patients receiving implantable cardioverter-defibrillator for cardiac resynchronization therapy (CRT-D) are likely to undergo one or more device replacements after the first implantation, mainly for battery depletion. We assessed the economic impact of longevity and device replacement from a healthcare service perspective in a real-world cohort of patients. Method used: We analyzed data on 1,400 patients implanted with a CRT-D between January 2008 and March 2010 in 9 Italian centers, and followed-up until 2014. Probabilities of replacement for battery depletion, stratified by device generation and manufacturer, were calculated up to 6 years. Public tariffs from diagnosis-related groups were used. All costs are expressed in Euro (E) and refer to the fiscal year 2015. Summary of results: A total of 1,792 implantation/replacement procedures were performed during the observation period. The generators were from 3 manufacturers: Medtronic (973, 54%), Boston Scientific (667, 37%), and St Jude Medical (152, 8%). The Italian healthcare system spent E34 million for CRT-D therapy in the participating hospitals over the observation period. The initial implant cost was E30,679. The probability of replacement at 6 years was 83% and 68% for earlier-and recent-generation devices (released before and after 2007), respectively. Over 6 years, the cost for replacement perpatient decreased by 30%, from E9,092 for earlier-generation to E6,953 for recent-generation devices, with a decrease of 6% in the overall cost of therapy...