Preventing Death in Heart Patients
Rhythm problems and congestive heart failure are two of the main end results of all heart problems. The congestive heart failure in the advanced stages carries a long term prognosis worse than that of cancer. The rhythm problems involving the lower chamber like ventricular tachycardia and ventricular fibrillation can lead to sudden death.
A study called MADIT-II involved patients who had very low ejection fraction (ejection fraction is a measure of pumping power of the heart muscles) due to blockages of heart arteries. The study showed that a defibrillator (also called ICD) can help prevent sudden death in these patients. The defibrillator is sometimes called shock box in every day lingo. A defibrillator is like a pacemaker that is usually implanted under the collar bone. The computer in this machine can detect and try to treat any serious heart rhythm problems that could potentially lead to death.
Another study called SCDHeFT {pronounced as scud-heft (as in theft)} involved persons who had weak heart muscles regardless of the cause. In MADIT-II study above, the heart muscle damage had to be from blocked heart arteries. The study showed that these patients will benefit from ICD as long as they got short of breath on every day ordinary or less than ordinary activities (said to be belonging to NYHA class 2 to 3 in scientific lingo).
These two studies have made millions of patients eligible for defibrillators. Because of logistical as well as financial constraints, there is a need for prioritization. A recent study published in the journal Circulation (Circulation. 2006; 114:135-142*) has studied the cost-effectiveness of defibrillators in patients in SCDHeFT study detailed above. If you care, SCDHeFT stands for Sudden Cardiac Death in Heart Failure Trial.
The study shows that ICD is cost-effective in patients that meet all of the following criteria:
Have weak heart muscles (ejection fraction down to ≤35%)
Get short of breath on ordinary activities
Get defibrillator with single chamber pacemaker
Be expected to live more than 8 years
My take on the study:
It is hard to try to put a dollar figure on human life. When it comes to our own loved ones, rationing the medical care can make us angry. However, the limited numbers of dollars available demand prioritization. According to this study:
The ICDs are not cost-effective in the patients that become short of breath on less than ordinary activity or at rest.
We do know that patients that have very weak heart muscles may also have other problems that may seriously impair their life span. According to this study, the ICD is cost-effective if a person is expected to live more than 8 years.
The cost-effectiveness was measured based on the cost associated with single wire pacemaker. The trend lately has been to implant two or even three wire pacemakers with defibrillator. The calculation based on much more expensive two or three lead pacemakers will make these ICDs look much less cost-effective
The development of sophisticated ICDs is one of the major developments in the field of cardiology. Offering an ICD based purely on the basis of weakness of heart muscles is a relatively new field. There is a need for identifying the patients that ICDs may help the most, so that we do not squander our resources by the time we get to them.
*In case you are wondering, this information with all the numbers can be used to get to the original Circulation article.
A study called MADIT-II involved patients who had very low ejection fraction (ejection fraction is a measure of pumping power of the heart muscles) due to blockages of heart arteries. The study showed that a defibrillator (also called ICD) can help prevent sudden death in these patients. The defibrillator is sometimes called shock box in every day lingo. A defibrillator is like a pacemaker that is usually implanted under the collar bone. The computer in this machine can detect and try to treat any serious heart rhythm problems that could potentially lead to death.
Another study called SCDHeFT {pronounced as scud-heft (as in theft)} involved persons who had weak heart muscles regardless of the cause. In MADIT-II study above, the heart muscle damage had to be from blocked heart arteries. The study showed that these patients will benefit from ICD as long as they got short of breath on every day ordinary or less than ordinary activities (said to be belonging to NYHA class 2 to 3 in scientific lingo).
These two studies have made millions of patients eligible for defibrillators. Because of logistical as well as financial constraints, there is a need for prioritization. A recent study published in the journal Circulation (Circulation. 2006; 114:135-142*) has studied the cost-effectiveness of defibrillators in patients in SCDHeFT study detailed above. If you care, SCDHeFT stands for Sudden Cardiac Death in Heart Failure Trial.
The study shows that ICD is cost-effective in patients that meet all of the following criteria:
Have weak heart muscles (ejection fraction down to ≤35%)
Get short of breath on ordinary activities
Get defibrillator with single chamber pacemaker
Be expected to live more than 8 years
My take on the study:
It is hard to try to put a dollar figure on human life. When it comes to our own loved ones, rationing the medical care can make us angry. However, the limited numbers of dollars available demand prioritization. According to this study:
The ICDs are not cost-effective in the patients that become short of breath on less than ordinary activity or at rest.
We do know that patients that have very weak heart muscles may also have other problems that may seriously impair their life span. According to this study, the ICD is cost-effective if a person is expected to live more than 8 years.
The cost-effectiveness was measured based on the cost associated with single wire pacemaker. The trend lately has been to implant two or even three wire pacemakers with defibrillator. The calculation based on much more expensive two or three lead pacemakers will make these ICDs look much less cost-effective
The development of sophisticated ICDs is one of the major developments in the field of cardiology. Offering an ICD based purely on the basis of weakness of heart muscles is a relatively new field. There is a need for identifying the patients that ICDs may help the most, so that we do not squander our resources by the time we get to them.
*In case you are wondering, this information with all the numbers can be used to get to the original Circulation article.
posted by kc at 12:44 PM
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