But electrophysiologists prescribed the smallest proportion of the possibly unneeded ICDs, the researchers found. Most were implanted by thoracic surgeons and nonelectrophysiologist cardiologists.
Dr. Alan Kadish, president and chief executive officer of Touro College in New York City and author of an accompanying journal editorial, said some of the so-called unneeded ICDs were probably implanted for good reason.
"There are some people where the guidelines are gray, where implantation is probably appropriate," he said. "But there are still a significant number of people who receive ICDs who don't need them based on current criteria," he added.
Kadish suggested several reasons for the unnecessary ICD implants: lack of knowledge about the guidelines or gray areas of the guidelines where an ICD might improve patient outcome despite not being spelled out in the criteria.
"There may be some physicians who are just inappropriately putting them in," Kadish said, "but I think that's a minority of the out-of-guideline implantations."
Money is not really an incentive for doctors to implant ICDs, he said. The procedure can cost $50,000 or more, most of which covers the cost of the device and hospital fees. Only a small portion goes to the doctor, he said.
If your doctor wants to prescribe an ICD, Kadish advises asking if its use meets guidelines or if it is the right thing to do even though it doesn't meet guidelines.
Dr. Gregg Fonarow, an American Heart Association spokesman and professor of cardiology at the University of California, Los Angeles, said the findings point to "the need to enhance evidence-based care and quality feedback to health-care providers" regarding ICD use.
Feedback to hospitals can improve adherence to the guideline recommend
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