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Many May Get Unneeded Implantable Defibrillators
Date:1/5/2011

By Steven Reinberg
HealthDay Reporter

TUESDAY, Jan. 4 (HealthDay News) -- About 20 percent of U.S. patients who receive an implantable cardioverter-defibrillator (ICD) may not need it, a new study finds.

Patients who receive out-of-guideline ICDs are put at higher risk of death and serious complications than patients who meet the criteria for the life-saving device, the researchers say in the Jan. 5 issue of the Journal of the American Medical Association.

"Our findings highlight the importance of enhancing health-care practitioners' adherence to evidence-based practice," said lead researcher Dr. Sana M. Al-Khatib, an associate professor of medicine at the Duke Clinical Research Institute.

"There is a tremendous opportunity for improvement in site performance," she added.

For patients with advanced systolic heart failure, an ICD can prevent sudden cardiac death. However, guidelines recommend against its use in patients recovering from a heart attack or bypass surgery or those with severe heart failure symptoms or a recent diagnosis of heart failure, the researchers explained.

To determine how many ICDs are implanted outside the guidelines, Al-Khatib and colleagues analyzed records from the National Cardiovascular Data Registry's ICD Registry between January 2006 and June 2009.

During that time, 111,707 ICDs were implanted, of which 25,145 (22.5 percent) did not meet current criteria, the researchers found.

Among patients who received out-of-guideline implants, 36.8 percent had had a heart attack and 62.1 percent suffered from heart failure.

Slightly more in-hospital deaths occurred among the out-of-guideline group than among those whose ICD met the guidelines (0.57 percent versus 0.18 percent) and their risk for complications was also higher (3.23 percent versus 2.41 percent), the research team found.

Overall, most ICDs were implanted by electrophysiologists (66.
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