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[We implant too many ICD - contra].
1Innere Medizin - Kardiologie und Intensivmedizin, Klinik Augustinum München, Wolkerweg 16, 81375, München, Deutschland. block@med.augustinum.de.
Herz
|February 14, 2016
Summary
Sudden cardiac deaths (SCD) are a significant concern, with many individuals over 55 needing an implantable cardioverter defibrillator (ICD). Current ICD use and guidelines suggest more patients could benefit from this life-saving technology.
Area of Science:
- Cardiology
- Public Health
Background:
- Sudden cardiac death (SCD) affects a substantial number of individuals over 55 in Germany, estimated at 120,000 annually.
- In 2014, only 30,000 implantable cardioverter defibrillators (ICDs) were implanted, falling short of the estimated need.
Purpose of the Study:
- To evaluate the current need and utilization of ICDs for primary prevention of SCD.
- To assess the effectiveness of ICDs in reducing mortality based on existing guidelines and recent technological advancements.
Main Methods:
- Analysis of prospective population-based cohort studies from the Netherlands.
- Review of data on ICD implantation rates and guideline adherence in Germany.
- Comparison of survival outcomes between historical ICD patient cohorts and contemporary patients receiving advanced ICD therapy.
Main Results:
- A significant gap exists between the estimated number of individuals who could benefit from an ICD and the actual number implanted.
- Despite challenges in predicting SCD, ICDs are underutilized, with only about one-third of patients utilizing them during battery life.
- Studies indicate that approximately six patients require ICD treatment to save one life over 8 years for ischemic cardiomyopathy.
- Current ICD implantations in Germany (94% in 2014) largely follow established guidelines, which are based on major randomized trials.
Conclusions:
- There is a compelling need for increased ICD implantation for primary SCD prevention in eligible patient populations.
- Advancements in ICD technology, including improved programming, cardiac resynchronization, and telemonitoring, offer potential for enhanced patient survival compared to earlier trials.
- Guidelines for ICD implantation remain relevant, but ongoing evaluation and potential expansion of indications may be warranted given technological progress.