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Disparity in use of implantable devices to prevent sudden death in heart failure patients
Date:12/18/2009

hose with a dedicated heart failure clinic and those staffed with heart rhythm disorder specialists called electrophysiologists.

The researchers note several limitations to the interpretation of the data. A proportion of the records of patients who appeared to be ICD-eligible lacked critical details that may have accounted for the decision not to use the devices. For example, functional capacity, a key measurement of heart disease severity and prognosis, was documented for only 66.5 percent of patients. Similarly, race was not consistently documented throughout the study group, potentially obscuring the true influence of race in the decision to use ICD therapy. ICD usage in eligible patients may be overestimated in this study because the data came from self-selected cardiology practices willing to participate in a quality improvement initiative.

Dr. Mehra says concerns about costs may also have figured in the decision of some cardiologists not to use ICD therapy in certain eligible patients. The cost of the devices and the professional and technical fees associated with their implantation and maintenance totals about $50,000. He says the devices have been shown to be cost-effective in the long run. But he adds that it may be necessary to develop more refined criteria for implantation, to make it easier to predict which patients might actually benefit from the devices.

"This research provides useful insight into an apparent gap in patients receiving a recommended therapy in the United States," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine. "Whether the gap is the result of medical or societal factors, concerns about costs, or other issues, Dr. Mehra's study is an important benchmark in the effort to understand how best to treat people with debilitating heart disease."

Heart failure affects nearly 5 million Ameri
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Contact: BILL SEILER
bseiler@umm.edu
410-328-8919
University of Maryland Medical Center
Source:Eurekalert

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