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January 5, 2011

Selecting Patients for ICD ImplantationAre Clinicians Choosing Appropriately?

Author Affiliations

Author Affiliations: Touro College, New York, NY (Dr Kadish); and Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Drs Kadish and Goldberger).

JAMA. 2011;305(1):91-92. doi:10.1001/jama.2010.1939

Large-scale registries provide an important window into how medicine is actually practiced. In this issue of JAMA, Al-Khatib et al1 examined the National Cardiovascular Data Registry's (NCDR’s) Implantable Cardioverter-Defibrillator (ICD) Registry to determine how often ICD implantations were performed in patients who did not meet criteria suggested in current guidelines for ICD use2; specifically, ICD implantation within 40 days of an acute myocardial infarction (MI) or within 3 months of coronary artery bypass graft (CABG) surgery, recent diagnosis of congestive heart failure (CHF), and presence of New York Heart Association (NYHA) class IV symptoms. Al-Khatib et al1 found that almost one-quarter of ICD implantations were performed in patients with these characteristics, mortality and complication rates were higher among these patients than for patients who received an ICD based on evidence-based guidelines, and nonelectrophysiologists performed non–guideline-based ICD implantations with a higher frequency than electrophysiologists. These findings should be used to inform public health policies toward the appropriate use of this life-saving but expensive technology.

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