omg

Certainly there are "unnecessary ICD's" but the majority of the unnecessary devices are implants that would not be performed by talented up to date cardilogists or electrophysiologists ( i.e. no RECENT MI or NEW CHF.)
I always enjoy explaining media hyped stories to my patients who become skeptical after a news flash. Maybe we should focus on the the fact that 1/12 implants done appropriately will have life saving therapy at 18 months. I hope all the media hype doesn't prevent lifesaving therapy. PS find a good cardiologist before your implant.

5 Comments

I agree with the doc

by ElectricFrank - 2011-01-14 02:01:15

I realize that the decision to implant an ICD is ususlly a judgment call. As such it needs to be done by a talented up to date cardiogist or electrophysiologist. A growing problem in the field is that it is being done more and more by any old doc. The pacemaker manufacturers are adding to the problem by providing automated programmers that avoid needing a knowledge of the electrical and timing issues involved.

Even under the best of conditions the 1/12 implants having a beneficial outcome is well worth while. The problem is when one is implanted just for CYA purposes or $$$ when a pacer would be appropriate.

From my perspective I rejoice when I find a doctor with real expertise in a field I need. It takes a number of visits before we can work as a team, but it is a great feeling.

best,

frank

Question

by agelbert - 2011-01-14 03:01:07

Doctor, are you aware that the FDA in the USA prohibits the donation of a functional harvested ICD or PM from a deceased person to a needy patient here or abroad? I understand the sterilization process is quite adequate so increased infection risk should not be a factor. What do you think about this?
I am sure that a doctor's decision to implant is justified. I recently read at the Medtronic web site that the problem in the USA is actually the reverse. Many doctors are NOT implanting patients that qualify for an ICD or PM. According to Medtronic, it's not a borderline issue. The issue only correlates to African Americans. I am not an African American but this concerns me and I'm sure it concerns you and many health care professionals as a matter of justice.
I recommend you visit the Medtronic web site and, since as a doctor you will have special access, read their investigative report.
I am not a doctor. I have had a PM for four years now.

maybe hyped but...

by golden_snitch - 2011-01-14 04:01:35

This story/study was indeed "hyped". However, it was originally published in JAMA, a very well known, peer-reviewed medical journal so if this journal accepts an article about a study like this ICD story, then there is something about this study.

When I posted the article here, I thought that it might be interesting for some, and because I have the feeling that there is much info out there that is never communicated to the patient (if for example patients taking Pradaxa had been told more about the study protocol, they would, for sure, not take it). There are patients here who have to make a decision about getting or not getting a pacer or ICD. Not everyone here gets good advice from their cardio.
And I believe that it's very important for a patient to get informed, and not just let the doctor decide. This is your body, your responsibility, your decision, you have to live with it, not the doctor.
And if there's only one patient here who had just had a heart attack - the study was only about unneccessary implants right after MI or newly diagnosed CHF - and has been told he should get an ICD but doesn't have a good feeling about it, and who was able to make a decision because of this article, it's been worth posting it.

Best
Inga



I dont

by walkerd - 2011-01-14 06:01:43

know who is comfortable about getting a devise implanted. I guess I would fit into the class of having a heartattack and newly diagnosed with CHF and a month later after my highrisk bypass was implanted with a pm/defib wasnt comfortable with it but my cardio wanted me to have it since it could save my life if I have another heartattack, was it necessary I sure hope not.

dave

Yes

by lenora - 2011-01-14 12:01:54

You've got some folks who read the headline off a Google News story and take it as gospel. And a whole bunch more who get their medical advice from anonymous strangers over the internet and actually are willing to believe a stranger rather than their personal physician. Thanks for posting. I'm a cath lab RN and I work some really terrific interventional cardiologists and EPs every day.

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