Incidence and predictors of MRI scan utilization in MRI-conditional pacemaker recipients: A multicenter experience.

BACKGROUND: Patient characteristics, higher device cost, and vendor contracts likely prevent use of magnetic resonance imaging (MRI)-conditional pacemakers (MRC) in all pacemaker (PM)-eligible patients. We sought to identify the incidence and predictors of MRI scan utilization in MRC recipients. METHODS: Patients receiving an MRC or non-MRI-conditional PM (NMRC) at four centers were included. Incidence of MRI scans following PM insertion was obtained from hospital records and patient phone calls. RESULTS: Of 1,244 patients (74 ± 12 years, 54.6% male), 927 had MRC and 317 had NMRC. At baseline, MRC recipients had a higher incidence of atrial tachycardia and MRI risk factors (syncope, recurrent falls, neurological disease, severe musculoskeletal disease, malignancy). In the MRC group, more patients had commercial health insurance (26% vs 15%, P < 0.001). Sixty MRC patients (6.5%) had an MRI during 21 ± 17 months' follow-up. Using the Weilbull parametric survival model, the projected percentage of MRC patients receiving an MRI scan at 7- and 11-year follow-up were 45% and 73%, respectively. By multivariate regression, a prior history of MRI (odds ratio [OR] 4.5, 95% confidence interval [CI] 2.2-9.1, P < 0.001) and active smoking (OR 2.65, 95% CI 1.1-6.7, P  =  0.039) independently predicted the performance of an MRI following MRC implant. CONCLUSIONS: In this MRC cohort, MRI scan utilization during follow-up was low but projection analyses showed a higher incidence over the lifetime of the MRC. A history of prior MRI and active smoking independently predicted the performance of an MRI scan during follow-up.

Dietary interventions in the management of atrial fibrillation.

Atrial fibrillation (AF) represents the most common cardiac arrhythmia with significant morbidity and mortality implications. It is a common cause of hospital admissions, significantly impacts quality of life, increases morbidity and decreases life expectancy. Despite advancements in treatment options, prevalence of AF remains exceptionally high. AF is a challenging disease to manage, not just clinically but also financially. Evidence suggests lifestyle modification, including dietary changes, plays a significant role in the treatment of AF. This review aims to analyze the existing literature on the effects of dietary modifications on the incidence, progression, and outcomes of atrial fibrillation. It examines various dietary components, including alcohol, caffeine, omega-3 polyunsaturated fatty acids and minerals, and their impact on AF incidence, progression, and outcomes. The evidence surrounding the effects of dietary patterns, such as the Mediterranean and low carbohydrate diets, on AF is also evaluated. Overall, this review underscores the importance of dietary interventions as part of a comprehensive approach to AF management and highlights the need for further research in this emerging field.

Cost-effectiveness analysis of magnetic resonance imaging-conditional pacemaker implantation: Insights from a multicenter study and implications in the current era.

BACKGROUND: Magnetic resonance imaging (MRI)-conditional pacemakers (M-PPMs) grant patients greater accessibility to MRI scans. The cost-effectiveness of implanting M-PPM is unknown. OBJECTIVE: The purpose of this study was to determine the cost-effectiveness of M-PPM implantation. METHODS: Cost-effectiveness analysis was performed on patients receiving a M-PPM across 4 institutions. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the sum of the total incremental cost of implanting a M-PPM vs a conventional pacemaker and the cost of MRI scans by the utility of MRI scans in terms of quality-adjusted life-years (QALY) gained. QALY and lifespan of M-PPM (7-11 years) data were obtained from the literature. The benchmark of <$100,000 per QALY was used as the threshold for cost-effectiveness. Computer modeling/simulations were used to calculate the percentage of patients required to achieve this benchmark, to extrapolate the cumulative projected percentage of patients utilizing MRI scans over the lifespan of a M-PPM via the Weibull parametric survival model, and to conduct univariate and multivariate, probabilistic sensitivity analyses. RESULTS: The ICER during the follow-up period (21 ± 17 months) was $451,569. The cost-effectiveness ICER benchmark is reached 7.0 years postimplantation, when a projected 38% of recipients would receive MRI scans. The projected percentage of patients receiving MRI scans at 11 years was 58%, yielding an ICER of $74,221 per QALY. Henceforth, assuming increased MRI usage in regular PPM based on Centers for Medicare & Medicaid Services memo CAG00399R4 and decreased cost of M-PPM, M-PPM implantation is still cost-effective, with a lifetime ICER of $49,817 per QALY. CONCLUSION: M-PPM implantation is cost-effective over the lifespan of a M-PPM based on projected usage of MRI.