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Implantable Cardioverter Defibrillators Often Used On Unsuitable People

3 (1 votes) 20% of people who receive an ICD (implantable cardioverter-defibrillators) do not meet evidence-based guidelines for their use, and were found significantly higher risk of death in hospital compared with those who did meet the criteria, researchers from Duke Clinical Research Institute identified in the JAMA (Journal of the American Medical Association).

Implantable cardiac defibrillator or ICD is a device that is placed in the patient's body and is designed to recognize certain types of arrhythmias (abnormal heart rhythms) and fix them. For example, the ICD can recognize and correct rapid regular beating of the ventricles (ventricular tachycardia), or rapid irregular beating of the ventricles (ventricular fibrillation). Ventricles of the lower chamber of the heart. IBC provides precisely calibrated and timed electrical shock to restore normal heartbeat.

The authors explain that several studies have shown how effectively the ICD in preventing sudden cardiac death in patients with advanced systolic heart failure. However, the PTS is not recommended for primary prevention in those who are recovering from coronary artery bypass graft surgery, heart attack, or severe symptoms of heart failure, in accordance with practice guidelines. They are not recommended for patients with a diagnosis of heart failure or recent.

The authors wrote:

"The extent to which doctors in routine clinical practice following evidence-based recommendations are not clear."

Sana M. Al-Khatib, MD, MHS, and the teams went in search of the characteristics and hospital outcomes of individuals who received non-evidence-based IBC. They collected data from the National Cardiovascular Data Registry ICD registry in the period from January 2006 to June 2009.

25,145 primary ICD for primary prevention ICD implants, from a total of 111,707 occurred among non-evidence-based patients (22,5%), the researchers found. Of these, 36.8% (9257) occurred in patients within 40 days of a heart attack and 62.1% (15,604) among people with newly diagnosed heart failure.

Rates based on actual data of patients who received implants had 0.57% risk of death in hospital, compared with 0.18% risk in the evidence-based patients.

Rates based on actual data of patients who received implants had 3.23% risk of complications after the procedure, compared with 2.41% among others.

The authors wrote:

"Although the absolute difference in complications between the 2 groups is small, these complications can have a significant impact on" quality of life of patients and health care utilization, including length of hospital stay and costs. Importantly, these complications as a result of the procedures that were not clearly stated in the first place. Although a small risk of complications is acceptable when the procedure has been shown to improve results, no risk is acceptable if the procedure has no demonstrated benefit.

The researchers found that the risk of any adverse events and death were significantly higher among non-evidence-based recipient device, and their stay in hospital was longer (3 days compared with 1).

The following are the proportions of the ICD implants performed by various medical professionals: electrophysiologists 66,6% Non electrophysiologist cardiologists 24,8% of Thoracic Surgeons 2,6% 6,1% Other Professional authors wrote:

"In this period of limited resources and in conjunction with the Centers for Medicare & Medicaid Services' emphasis on quality improvement through the promotion of evidence-based medicine is becoming increasingly important to assess performance and the hospital to provide feedback to hospitals on their outcomes and compliance with clinical guideline recommendations. The provision of such feedback to the hospitals has the potential to improve the observance of the principles and ultimately patient outcomes.

.. Additional efforts should be aimed at improving adherence to evidence-based practice. "

Accompanying editorial by Alan Kadish, MD, Touro College, New York, and the Feinberg School of Medicine, Northwestern University, Chicago, and Jeffrey Goldberger, MD, Feinberg School of Medicine, Northwestern University, Chicago, say, that the cardiovascular community care act on the results of this research to improve public health.

They wrote:

"There are several important considerations. Further information and specific data necessary to characterize some of the questions such as how well the National Cardiovascular Data Registry captures some of the subtleties of ICD indications, and whether the reasons for the deviation from the principles can be captured accurately. Once this happens, it is possible that the alleged entry of data in the online system can be designed to provide immediate feedback regarding the presence or absence of scientific evidence for a particular patient prior to ICD implantation.

"It is likely that all doctors require further study to understand the basis of principles and potential of alternative approaches when the patient does not meet the guidelines for ICD implantation. In addition, as a matter of public policy, healthcare organizations must evaluate the quality of care and cost efficiency can be improved through mandatory guideline heart rhythm society for formal training in an approved training program for fellows. If properly applied, the results of Al al-Khatib and others can improve the practice model and the results, with a unique opportunity to do so while reducing health care costs. "

"Non-science-based ICD implantations in the United States" Sana M. Al-Khatib, MD, MHS; Ann Hellkamp, MS; Jeptha Curtis, MD, Daniel Mark, MD, MPH; Eric Peterson, MD; Gillian D. Sanders, PhD, Paul A. Heidenreich, MD, MS, Adrian F. Hernandez, MD, MHS; Lesley H. Curtis, Ph.D., Stephen Hammill, MD JAMA. 2011; 305 (1) :43-49. DOI: 10.1001/jama.2010.1915

Author Christian Nordqvist


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