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Are One-Third of Costly Implanted Heart Devices Unnecessary?

the follow-up period than those who hadn’t gotten an ICD. They were also 70 percent less likely to die suddenly due to a heart-rhythm disruption. But at the same time, the one-third of patients who had negative MTWA tests and then received ICDs were no less likely to die than those with similar test results who didn’t receive ICDs.

“This is the first study to demonstrate that a subset of patients who meet current criteria for defibrillator placement may not benefit at all from ICDs,” says Paul Chan, M.D., M.Sc., senior author and a fellow in cardiovascular medicine at the U-M Medical School. “Use of the MTWA test, which has been covered by Medicare since spring of 2006, could truly help us tell which ICD candidates will benefit most.”

In all, the authors calculate, one life could be saved every two years for every nine ICDs implanted in people with positive or inconclusive MTWA results. But it would take 76 ICD implantations in people with negative MTWA tests to save one life every two years.

The reductions in death risk were present even after the authors corrected for many other variables and differences between the two MTWA-positive and MTWA-negative groups.

Chan and his Ohio colleagues, led by first author Theodore Chow, M.D., FACC, of the Lindner Clinical Trial Center at Christ Hospital and the OHVC, have studied the use of MTWA in predicting patients’ risk for several years.

Last spring, they published results from the same group of ischemic cardiomyopathy patients, showing that the MTWA test was able to predict the risk of death from any cause, even after they adjusted the data for other heart-rhythm test results and medical issues.

Also in 2006, Chan and his colleagues from U-M and the VA Ann Arbor Health Services Research & Development Center of Excellence demonstrated how MTWA testing could reap hundreds of millions of dollars in savings for the Medicare system, and the taxpayers who su
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