Saturday, July 19, 2008

Is ICD therapy being over-prescribed to us?

Think about this. A couple of months ago I attended a conference on Hypertrophic Cardiomyopathy where a leading cardiologist presented a slide that showed the U.S. as the number one country in defibrillator implants in the world.

The graph showed the U.S. with 421 implants per million population (2003 data). Germany was a far second with 133 implants per million. All other countries followed, Japan being the last on the list, with only 17 implants per million.

Just look at the graph and you must ask yourself:

Why the huge gap between us and them?

Is ICD therapy being over-prescribed to us? On the contrary, experts say. Despite us being ahead of the rest by a 3 to 1 ratio disparity, some doctors (and device makers) say that we still have a long way to go before we can raise the U.S. number of implants to what it really should be.

They claim that Sudden Cardiac Arrest (SCA) continues to be a leading cause of death in this country and that clinical evidence clearly supports ICDs as first-line therapy for prevention of SCA.

So, I get it. We need to be implanting a lot more ICDs to get our doctors and device manufacturers happy. But how many more?

Dr. Anne Curtis, director of cardiology at the University of South Florida and former president of the Heart Rhythm Society (HRS), says that this number should be between 700 and 1,100!

During a talk at the HRS 2008 conference on May 16 in San Francisco, Dr. Curtis explained:

There’s been some analysis of Managed Care in Medicare Databases showing that ICD usage is 416 per million population in the United States which has been contrasted with an identified range of over 700 to 1,100 ICD candidates per million. So we are using ICDs in only about half of the eligible patients.

(Watch the video on Medtronic’s site. Registration is required.)

She’s not alone. The report cited by Dr. Curtis concludes that, based on discharge diagnoses, many patients who could benefit from ICDs are not receiving this therapy today. The report ends by suggesting that the reasons for this “underutilization” of ICDs in the U.S. should be addressed.

As a pace-free and shock-free ICD recipient, and in face of such disparity, I have to wonder if I really needed my device.

After all, at an estimated cost of $90,000 over a lifetime, and in a world where big business often puts money before ethics, it’s hard not to raise an eyebrow.

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