The implantable cardioverter-defibrillator: does everybody need one?
The implantable cardioverter-defibrillator (ICD) has emerged as an effective, but expensive, therapy for arrhythmic sudden cardiac death. ICD use has been increasing by 20% to 30% per year. Clinical trials have shown that the ICD can be effective for both the primary prevention and the secondary prevention of sudden cardiac death in selected populations. Despite the available trial evidence, several issues pertaining to ICD use remain unresolved, including the treatment of patients not represented in clinical trials, the optimal selection of patients who will benefit from an ICD, the duration of benefit from an ICD, the quality of life for patients with an ICD, and both the cost-effectiveness and the cost impact of the ICD. These considerations are discussed in this article.
Raj
S R
SR
Cardiovascular Research Group, Health Sciences Center, University of Calgary, Calgary, Alberta T2N 4N1, Canada.
Sheldon
R S
RS
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000628:therapy; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D006801:Humans; D015201:Meta-Analysis as Topic; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life
D000889:Anti-Arrhythmia Agents