Abstract
Riata and Riata ST defibrillator leads (St. Jude Medical, Sylmar, California) were recalled in 2011 due to increased risk of insulation failure leading to externalized cables. Fluoroscopic screening can identify insulation failure, although the relation between mechanical failure and electrical failure is unclear. At the time of the recall, the University of Virginia developed a screening program, including fluoroscopic evaluation, education sessions, device interrogation, and remote monitoring for patients with this defibrillator lead. The aim of this study was to review the outcomes of the screening program, including costs, which were absorbed by our institution. Costs were calculated using Medicare reimbursement estimates. Forty-eight patients participated in the screening program. At initial screening, 31% were found to have evidence of insulation failure but electrical function was normal in all leads. The cost of this program was $35,358.72. The cost per diagnosis of mechanical lead failure was $2,357.25. During 2 years of follow-up, 1 patient experienced Riata lead electrical failure without fluoroscopic evidence of insulation failure. Patients were more likely to have a lead revision if there was evidence of insulation failure. Lead revisions occurred at the time of generator change in 88% of patients with insulation failure but in only 14% of patients with a fluoroscopically normal lead (p = 0.04). The cost of recall-related defibrillator lead revisions was $81,704.55. In conclusion, our Riata screening program added expense without clear benefit to patients. In fact, patients may have been put at more risk by undergoing defibrillator lead revisions based solely on the results of the fluoroscopic screening.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 206-208 |
| Number of pages | 3 |
| Journal | American Journal of Cardiology |
| Volume | 115 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jan 15 2015 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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Cost of a recall of a single-center experience managing the riata defibrillator lead. / Hussain, Sarah; Moorman, Liza; Moorman, J. Randall; Dimarco, John P.; Malhotra, Rohit; Darby, Andrew; Bilchick, Kenneth; Mangrum, J. Michael; Ferguson, John D.; Mason, Pamela K.
In: American Journal of Cardiology, Vol. 115, No. 2, 15.01.2015, p. 206-208.Research output: Contribution to journal › Article
TY - JOUR
T1 - Cost of a recall of a single-center experience managing the riata defibrillator lead
AU - Hussain, Sarah
AU - Moorman, Liza
AU - Moorman, J. Randall
AU - Dimarco, John P.
AU - Malhotra, Rohit
AU - Darby, Andrew
AU - Bilchick, Kenneth
AU - Mangrum, J. Michael
AU - Ferguson, John D.
AU - Mason, Pamela K.
PY - 2015/1/15
Y1 - 2015/1/15
N2 - Riata and Riata ST defibrillator leads (St. Jude Medical, Sylmar, California) were recalled in 2011 due to increased risk of insulation failure leading to externalized cables. Fluoroscopic screening can identify insulation failure, although the relation between mechanical failure and electrical failure is unclear. At the time of the recall, the University of Virginia developed a screening program, including fluoroscopic evaluation, education sessions, device interrogation, and remote monitoring for patients with this defibrillator lead. The aim of this study was to review the outcomes of the screening program, including costs, which were absorbed by our institution. Costs were calculated using Medicare reimbursement estimates. Forty-eight patients participated in the screening program. At initial screening, 31% were found to have evidence of insulation failure but electrical function was normal in all leads. The cost of this program was $35,358.72. The cost per diagnosis of mechanical lead failure was $2,357.25. During 2 years of follow-up, 1 patient experienced Riata lead electrical failure without fluoroscopic evidence of insulation failure. Patients were more likely to have a lead revision if there was evidence of insulation failure. Lead revisions occurred at the time of generator change in 88% of patients with insulation failure but in only 14% of patients with a fluoroscopically normal lead (p = 0.04). The cost of recall-related defibrillator lead revisions was $81,704.55. In conclusion, our Riata screening program added expense without clear benefit to patients. In fact, patients may have been put at more risk by undergoing defibrillator lead revisions based solely on the results of the fluoroscopic screening.
AB - Riata and Riata ST defibrillator leads (St. Jude Medical, Sylmar, California) were recalled in 2011 due to increased risk of insulation failure leading to externalized cables. Fluoroscopic screening can identify insulation failure, although the relation between mechanical failure and electrical failure is unclear. At the time of the recall, the University of Virginia developed a screening program, including fluoroscopic evaluation, education sessions, device interrogation, and remote monitoring for patients with this defibrillator lead. The aim of this study was to review the outcomes of the screening program, including costs, which were absorbed by our institution. Costs were calculated using Medicare reimbursement estimates. Forty-eight patients participated in the screening program. At initial screening, 31% were found to have evidence of insulation failure but electrical function was normal in all leads. The cost of this program was $35,358.72. The cost per diagnosis of mechanical lead failure was $2,357.25. During 2 years of follow-up, 1 patient experienced Riata lead electrical failure without fluoroscopic evidence of insulation failure. Patients were more likely to have a lead revision if there was evidence of insulation failure. Lead revisions occurred at the time of generator change in 88% of patients with insulation failure but in only 14% of patients with a fluoroscopically normal lead (p = 0.04). The cost of recall-related defibrillator lead revisions was $81,704.55. In conclusion, our Riata screening program added expense without clear benefit to patients. In fact, patients may have been put at more risk by undergoing defibrillator lead revisions based solely on the results of the fluoroscopic screening.
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UR - http://www.scopus.com/inward/citedby.url?scp=84919681023&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2014.10.028
DO - 10.1016/j.amjcard.2014.10.028
M3 - Article
C2 - 25479754
AN - SCOPUS:84919681023
VL - 115
SP - 206
EP - 208
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 2
ER -