Proportion of patients needing an implantable cardioverter defibrillator on the basis of current guidelines: impact on healthcare resources in Italy and the USA. Data from the ALPHA study registry.
OBJECTIVE
Implantable cardioverter defibrillators (ICD) improve survival in selected patients with left ventricular dysfunction or heart failure (HF). The objective is to estimate the number of ICD candidates and to assess the potential impact on public health expenditure in Italy and the USA.


RESULTS
Data from 3513 consecutive patients (ALPHA study registry) were screened. A model based on international guidelines inclusion criteria and epidemiological data was used to estimate the number of eligible patients. A comparison with current ICD implant rate was done to estimate the necessary incremental rate to treat eligible patients within 5 years. Up to 54% of HF patients are estimated to be eligible for ICD implantation. An implantation policy based on guidelines would significantly increase the ICD number to 2671 implants per million inhabitants in Italy and to 4261 in the USA. An annual increment of prophylactic ICD implants of 20% in the USA and 68% in Italy would be necessary to treat all indicated patients in a 5-year timeframe.


CONCLUSIONS
Implantable cardioverter defibrillator implantation policy based on current evidence may have significant impact on public health expenditure. Effective risk stratification may be useful in order to maximize benefit of ICD therapy and its cost-effectiveness in primary prevention.
Pedretti
Roberto F E
RF
1Division of Cardiology, IRCCS Salvatore Maugeri Foundation, Scientific Institute of Tradate (VA), Castellanza (VA), Italy.
Curnis
Antonio
A
Massa
Riccardo
R
Morandi
Fabrizio
F
Tritto
Massimo
M
Manca
Lorenzo
L
Occhetta
Eraldo
E
Molon
Giulio
G
De Ferrari
Gaetano M
GM
Sarzi Braga
Simona
S
Raciti
Giovanni
G
Klersy
Catherine
C
Salerno-Uriarte
Jorge A
JA
D000328:Adult; D000368:Aged; D002017:Budgets; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011634:Public Health / Q000191:economics / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D055815:Young Adult