Effect of ICD/CRT-D Implantation on Adverse Events and Readmission Rate in Patients with Chronic Heart Failure (CHF)

Abstract

Objective. To explore the effect of implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator (ICD/CRT-D) implantation on adverse events and the readmission rate in patients with chronic heart failure (CHF). Methods. Sixty patients with CHF treated in our hospital from April 2019 to July 2021 were enrolled. The patients were randomly assigned into the control group and study group. The control group received routine intervention, and the study group received remote management with ICD/CRT-D implantation. Results. First of all, we compared the general data of the two groups. There was no significant difference in LVEF, NYHA grade, concomitant disease, and history of arrhythmia ( $P>0.05$ ). Secondly, we compared the end-point events. In the study group, 5 cases of heart failure were readmitted, 0 cases died, and 4 cases were admitted to hospital with arrhythmia and ICD events, with a total incidence of 30.0%, while in the control group, 12 cases were rehospitalized with heart failure, 3 cases died, 25 cases were admitted with arrhythmia and ICD events, and the total incidence rate was 56.67% ( $P<0.05$ ). In terms of the readmission rate of patients with heart failure in grade NYHAII and grade III, among the patients with grade NYHAII, the number of patients with heart failure less than once in the study group was higher compared to that in the control group and the number of patients with heart $\text{failure}\ge \text{once}$ in the study group was lower compared to that in the control group ( $P<0.05$ ). Among the patients with grade NYHAIII, the number of patients with heart failure less than once in the study group was higher compared to that in the control group and the number of patients with heart $\text{failure}\ge \text{once}$ in the study group was lower compared to that in the control group. There exhibited no significant difference in the data ( $P>0.05$ ). Considering the occurrence of VT and VF events, the study team reported that 14 patients recorded a total of 276 ventricular arrhythmias: 261 ventricular tachycardia and 15 ventricular fibrillations. Among them, 24 VT (9.2%) and 4 VF (26.7%) were determined to be misrecognition of the equipment. A total of 178 ventricular arrhythmias were recorded in 13 patients in the control group, including 152 ventricular tachycardia and 26 ventricular fibrillations. Among them, 10 VT (6.6%) and 8 VF (30.8%) were determined as misrecognition of the device. In regard to the treatment results of the two groups, after admission to the hospital for radio frequency, ablation, and adjustment of drug treatment to reprogram control, the patients did not reappear to have CRT-D misidentification and misdischarged. Finally, we compared the diagnosis time of VT/VE events. The time from VT/VE events to diagnosis in 14 patients in the study group was $2.55\pm 1.41$ days, and that in 13 patients in the control group was $37.32\pm 15.31$ days. The discovery of ICD events in the study group was significantly earlier compared to that in the routine follow-up group ( $P<0.05$ ). This gives doctors enough time to assess the patient’s condition and determine a further diagnosis and treatment plan. Conclusion. Using ICD/CRT-D implantation to remotely monitor patients with CHF, through remote monitoring of the 24-hour average heart rate and the heart rate at rest and patient activity and other parameters and early intervention, the readmission rate caused by the deterioration of heart failure can be reduced. Compared with routine follow-up, remote monitoring significantly reduced the diagnosis time of VT/VE events.