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April 1, 2026ClinicoEconomics and Outcomes Research0 citationsOpen Access

Healthcare Utilization and Costs After Appropriate or Inappropriate Implantable Defibrillator Shocks: A Retrospective Real-World Data Study in Japan

TNTakashi NodaTMTomoko MatsumotoYTYuji Tanaka

Key Result

Appropriate ICD/CRT-D shocks were associated with longer hospital stays (24.6 vs. 12.5 days) and higher healthcare costs (1,123,531 vs. 67,091 JPY) compared to inappropriate shocks.

Key Points

  • This study examines healthcare utilization and costs after ICD/CRT-D shocks in Japan.
  • Analyzed real-world data from four tertiary hospitals
  • Retrospective design covering data from January 2022 to June 2024
  • Identified 84 patients who experienced at least one ICD/CRT-D shock
  • 146 ICD/CRT-D shock events were recorded.
  • Majority of shocks (83.6%) were appropriate; 16.4% were inappropriate.
  • Hospitalization was required in 37.7% of cases.
  • Appropriate shocks resulted in longer hospital stays (average 24.6 days) and higher costs (average ¥1,123,531).

Study Design

Type

Observational (n=84)

Multicenter

Yes

Structured PICO

Do appropriate ICD/CRT-D shocks result in different healthcare utilization and costs compared to inappropriate shocks in adult patients?

P
Population
84 adult patients (aged ≥18 years) with ICD/CRT-D implantation who visited the hospital at least once following an ICD/CRT-D shock event (identified from a broader cohort of 1,807 implanted patients). Mean age 65 ± 14 years, 86.9% male, based in Japan.
I
Intervention
Appropriate ICD/CRT-D shock events (delivered for true ventricular tachyarrhythmias including ventricular tachycardia/ventricular fibrillation)
C
Comparator
Inappropriate ICD/CRT-D shock events (delivered for any other type of detected rhythm, including atrial fibrillation, supraventricular tachycardia, T-wave oversensing, or noise)
O
Outcome
ICD/CRT-D shock-related healthcare utilization (HCU) and expenditures resulting from the HCU at the time of the post-shock hospital visit

Appropriate ICD/CRT-D shocks are associated with substantially higher healthcare utilization, longer hospital stays, and greater costs compared to inappropriate shocks in the Japanese clinical setting.

Main Result

Absolute Event Rate: 1123531% vs 67091%

Limitations

  • Descriptive study based on secondary real-world data, not designed to evaluate causal relationships
  • Small sample size and use of aggregated data prevented formal sensitivity analyses and adjustment for unmeasured confounding
  • Data from only four hospitals over a 2.5-year period may limit generalizability to the broader patient population in Japan
  • Inability to follow patients transferred to hospitals not covered by the data system
  • Baseline information based on prior medical history may be insufficient
  • Difficulty capturing deaths that occurred outside the covered hospitals
  • Potential inadvertent inclusion of patients without actual shock events
  • Lack of access to individual patient-level data
  • Access only to aggregated data preventing statistical significance tests between appropriate and inappropriate shock events

Abstract

Background: Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy with defibrillators (CRT-Ds) effectively prevent sudden cardiac death. However, there is a lack of detailed data on healthcare utilization and healthcare cost following ICD/CRT-D shock events in Japan. This study aimed to examine real-world data (RWD) stored in an emergency department system to clarify healthcare utilization and healthcare costs associated with ICD/CRT-D shocks in Japan. Methods and Results: This retrospective study analyzed RWD from four tertiary hospitals between January 2022 to June 2024. Among 1,807 ICD/CRT-D implanted adult patients, 84 patients (4.6%) who visited the hospital at least once following an ICD/CRT-D shock event were identified. Of these, a total of 146 ICD/CRT-D shock events were observed, with 33 patients (39.3%) experiencing multiple episodes. Of these, 122 (83.6%) were appropriate and 24 (16.4%) were inappropriate. Hospitalization was required in 55 (37.7%) cases. Appropriate shocks were associated with longer hospital stays (24.6 ± 29.3 vs. 12.5 ± 4.2 days) and higher costs (1,123,531 ± 2,195,483 JPY vs. 67,091 ± 131,282 JPY) than inappropriate shocks. Conclusion: In this multicenter retrospective study using real-world data in Japan, we investigated the healthcare utilization and costs associated with ICD/CRT-D shock events. Our findings provide valuable insight into post-shock care in daily practice and highlight the need for optimized management strategies to improve care delivery and resource use in the Japanese clinical setting. Keywords: implantable cardioverter-defibrillator, healthcare cost, retrospective real-world data analysis

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Cite This Study

Noda et al. (2026) conducted an observational in ICD/CRT-D shock events (n=84). Appropriate ICD/CRT-D shocks vs. Inappropriate ICD/CRT-D shocks was evaluated on Healthcare costs (JPY). Appropriate ICD/CRT-D shocks were associated with longer hospital stays (24.6 vs. 12.5 days) and higher healthcare costs (1,123,531 vs. 67,091 JPY) compared to inappropriate shocks.

synapsesocial.com/papers/69cd7b065652765b073a8b77https://doi.org/10.2147/ceor.s577970
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