22.5% implanted defibrillators are unnecessary: Study

According to a new study nearly 20% of American patients who receive an implantable cardioverter-defibrillator (ICD) may not need it. These ICDs when unnecessary could put the patients at higher risk of death and serious complications than patients who meet the criteria for the life-saving device say authors of the study published in the Jan. 5 issue of the Journal of the American Medical Association.

According to lead researcher Dr. Sana M. Al-Khatib, an associate professor of medicine at the Duke Clinical Research Institute, “Our findings highlight the importance of enhancing health-care practitioners’ adherence to evidence-based practice… There is a tremendous opportunity for improvement in site performance.” She explained that in patients with advanced systolic heart failure, an ICD can prevent sudden cardiac death. However this move is not necessary in patients recovering from a heart attack or bypass surgery or those with severe heart failure symptoms or a recent diagnosis of heart failure as per guidelines.

The team analyzed records from the National Cardiovascular Data Registry’s ICD Registry between January 2006 and June 2009. Within this time frame a total of 111,707 ICDs were implanted, of which 25,145 (22.5 percent) did not meet current criteria. Among these out-of-guideline patients 36.8 percent had had a heart attack and 62.1 percent suffered from heart failure. In-hospital deaths were 0.57 percent among non guidelines patients compared to 0.18 percent among those whose ICD met the guidelines. Risk of complications was higher with out-of-guideline group (3.23 percent) compared to within guideline (2.41 percent). Most of these ICDs were implanted by electrophysiologists (66.6 percent), followed by nonelectrophysiologist cardiologists (24.8 percent), thoracic surgeons (2.6 percent) and other specialists (6.1 percent), the study authors noted. The electrophysiologists were the smallest prescriber of ICDs. Most were implanted by thoracic surgeons and nonelectrophysiologist cardiologists.

According to Dr. Alan Kadish, president and chief executive officer of Touro College in New York City and author of an accompanying journal editorial, there may be good reason for implanting the unnecessary ICDs. He said, “There are some people where the guidelines are gray, where implantation is probably appropriate… But there are still a significant number of people who receive ICDs who don’t need them based on current criteria.” He said some reasons for unnecessary ICD implants could be 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. He said, “There may be some physicians who are just inappropriately putting them in… but I think that’s a minority of the out-of-guideline implantations.”

According to Dr. Gregg Fonarow, an American Heart Association spokesman and professor of cardiology at the University of California, Los Angeles the study shows that there is a “need to enhance evidence-based care and quality feedback to health-care providers” regarding ICD use.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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Comments

  1. Defibrillator Tenant Defibrillator Tenant United States says:

    Implanting defibrillators has become like prescribing drugs with hospitals partnering with Medtronic, St. Jude Medical and Boston Scientific similar to how practitioners prescribe Pfizer and Lipitor.  I have an unnecessary defibrillator despite no heart disease, no plaque, no cholesterol, below normal blood pressure, and no diabetes. Hoag Hospital in Newport Beach implanted the ICD along with prescribing Lipitor despite no tests to support. The Boston Scientific defibrillator is constantly surging with the side effects of muscle constriction, black and blue skin, coldness and extreme weight loss on an already lean body.  Hoag, Boston Scientific along with electrophysiologists at Newport Heart Institute have basically taken up about 5% of space on my body with the protruding ICD that is constantly sore to touch.  Perhaps in years to come, they will pay rent for being a tenant on my body and the wear-and-tear on my health.  

  2. Unneeded Defibber Unneeded Defibber United States says:

    The 22.5% unnecessary ICDs correlates to the study's finding that implanting is by almost 35% non-electrophysiologists.  The so-called "hospitalists" from Internal Medicine are collaborating with insurance companies for approval of devices for general health instead of circumstances that are guidelined to life-threatening and evidence-based.  The preceding comments about "ICD Rouse" at Hoag Hospital were probably abetted by PacificHospitalists.com (PHA) that optimizes admissions, billing and insurance.  My experience with PHA was that the discharge report had a time stamp of almost two days before actual discharge and bundled with nine drugs stopped by specialists as unnecessary and causing side effects.  And the pre-dated discharge report was written by hospitalist Dr. Weston Chandler before the defibrillator was implanted to become another statistic in the 22.5% unnecessary ICDs.  I was discharged from Hoag with an ICD at 9pm on a Saturday night without seeing a doctor since the Friday noontime implant - they left for a three-day weekend on Thursday after composing an unfounded discharge report.

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