New study on longevity finds that Medtronic ICDs are superior.

From time to time the question of who makes the best ICD comes around (even if I’m the one bringing it up). But since there are few comparative studies among ICDs of different manufacturers, the answer is not an easy one.

Luckily, a study published by Europace late last year (Longevity of implantable cardioverter-defibrillators: implications for clinical practice and health care systems) helps shed some light on the topic of longevity.

A team of doctors in Bologna, Italy, looked into the longevity of Medtronic, Guidant and St. Jude Medical devices implanted from 1/1/2000 to 12/31/2002, a 3 year period.

They found that, under comparable conditions, Medtronic ICDs outlasted Guidant and St. Jude Medical devices, with replacement rates being, respectively, 42%, 95.3%, and 97.2%.

At the end of the follow-up period (12/31/07), 56 of 57 (97.2%) St. Jude Medical, 41 of 43 (95.3%) Guidant, and 10 of 24 (42%) Medtronic devices had been replaced. Among these 124 patients, 17 still had the device in service: 11 single-chamber ICDs (8 MDT, 2 GDT, 1 SJM), 2 dual-chamber ICDs (MDT), and 4 CRT-D (MDT).

At the time the study was done, St. Jude Medical and Guidant used Wilson Greatbatch batteries, while Medtronic devices had their own proprietary batteries.

Device longevity is a big deal to us, patients, since it translates into fewer replacements and a lower risk of complications. Longevity also has a significant impact on the cost per service life of an ICD. In other words, the up-front cost of a device is of limited value when estimating its long-term cost-effectiveness.

From a total of 153 patients:

• 80 received a single chamber ICD (1 lead)
• 59 received a dual-chamber ICD (2 leads)
• 14 received CRT-D devices (3 leads)

The bottom line? Medtronic ICDs last longer.

But I do have to wonder if the newer Boston Scientific devices COGNIS and TELIGEN with proprietary battery technology would have given the Medtronic devices a run for their money.

HCM patients with Blue Cross Blue Shield coverage in danger of loss of access to HCM center in Boston.

This news does not directly affect us in California, but it's a big deal to our HCM friends who are treated at the Hypertrophic Cardiomyopathy (HCM) clinic at Tufts Medical Center in Boston, MA.

The HCM Center at Tufts Medical Center is the first such treatment and research facility in the Northeast. It provides patients and their families with comprehensive, multidisciplinary treatment for this genetic heart disease that affects 1 in 500 people. Sudden cardiac death (SDC) due to HCM is a tragic complication of this disease and ICDs are an effective treatment to prevent SCD in select patients. The risk of sudden cardiac death ranges between 1-5% per year.

On January 31, 2009 Tufts Medical Center's contract with Blue Cross Blue Shield of Massachusetts (BCBSMA) will expire (read the news coverage here).

This means that those patients with procedures already planned will have a grace period of between 30 and 90 days to complete care. However, after that, their plan will no longer cover Tufts as a network provider. Patients with HMO coverage will not be permitted to go to Tufts and those with PPOs and other plans will be viewed as out of network.

Whether you personally have BCBSMA or use the services of Tufts should not matter. We all must speak out about this issue. Write to BCBSMA to urge them to negotiate in good faith and for the benefit of their patients. Your community, your family, your HCMA friends need your support now.

Watch this important message from Lisa Salberg, president of the Hypertophic Cardiomyopathy Association (HCMA).



Act now! The HCMA is asking everyone to write to grievances@bcbsma.com. You may use this sample letter:

To: Blue Cross Blue Shield of Massachusetts

I am a supporter of Tufts Medical Center and I value the hospital and its physicians as high-quality, efficient providers of excellent medical care. I was surprised and dismayed to learn that Blue Cross Blue Shield of Massachusetts is not paying reasonable rates for the services of these important health care providers at Tufts Medical Center and Floating Hospital for Children.

I believe this is unfair. I hope Blue Cross realizes that it must provide Tufts and its physicians, fair and reasonable reimbursements so that they can continue to offer expert care, as they have for over 200 years.

I strongly urge Blue Cross Blue Shield of Massachusetts to offer Tufts Medical and its physicians a reasonable rate increase and to resolve this issue as soon as possible.

Sincerely,
NAME HERE

Please take a moment to urge BCBSMA to negotiate in good faith and for the benefit of their patients. Tufts Medical Center and Floating Children's Hospital are a top rated, high quality system with a proven track record of cost effective health care, and one of only 17 programs nationally with a specialized HCM program.