title: [Implantable cardioverter-defibrillators: proposal of new criteria for the recognition of disability].
abstract: BACKGROUND
  Indications to the implantable cardioverter-defibrillator (ICD) have been expanded in the last decade, including patients suffering from heart disease with or without functional disorders. Accordingly, the increasing number of patients with ICD is posing relevant legal implications. Currently, the Medical Committee that evaluates the legal criteria for disability is employing guidelines referring only to pacemaker devices and not to ICD. The aim of this study was to propose new indications for patients with ICD to replace the current criteria.
  
  
  METHODS
  The study included 219 patients (83% male, mean age 63 years) with ICD who were administered an anonymous questionnaire to evaluate the presence of any disability. Most patients were suffering from ischemic or non-ischemic dilated heart disease (41% and 34%, respectively). Single- and dual-chamber ICD (72%) were more frequently implanted compared to biventricular ICD (28%).
  
  
  RESULTS
  A higher percentage of disability was found in older patients (69 +/- 14 years) with ischemic heart disease (61%) and single- or dual-chamber ICD before ICD implantation. Conversely, a lower percentage of disability was found in younger patients (53 +/- 15 years), active workers (44%), without ischemic or non-ischemic dilated heart disease (36%), and with a lower number of biventricular ICD (22%) after ICD implantation.
  
  
  CONCLUSIONS
  Overall, these data show that disability is currently recognized because of the presence of ICD rather than the underlying heart disease. We propose, therefore, new criteria that include the impact of the underlying heart disease for a better evaluation of disability in patients with ICD.
authors.affiliation: U.O. di Cardiologia, Dipartimento dell'Emergenza e dei Trapianti d'Organo, Università degli Studi, Bari. sfavale@cardio.uniba.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Favale
authors.forename: Antonietta
authors.initials: A
authors.lastname: Papa
authors.forename: Frida
authors.initials: F
authors.lastname: Nacci
authors.forename: Maria Carmela
authors.initials: MC
authors.lastname: Mascolo
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged