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September 27, 2004

Food for Afterthought: Reflections From 2 Implantable Cardioverter Defibrillator Trials

Arch Intern Med. 2004;164(17):1835-1839. doi:10.1001/archinte.164.17.1835

The prime goal is to alleviate suffering and to prolong life, and if your treatment does not alleviate suffering but only prolongs life, that should be stopped.—Christian Barnard1 (1922-2002), cardiac surgeon

Two valuable trials, Antiarrhythmics Versus Implantable Defibrillators (AVID)2 and Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II),3 have compared the survival of patients with an implantable cardioverter defibrillator (ICD) with that of patients treated with antiarrhythmic drug therapy. The importance of their findings demands a careful and detailed analysis of these trials. It is the purpose of this article to review these trials for (1) entry and exclusion criteria and the number of patients who entered the trial in relation to those screened and to those who met entry criteria; (2) baseline characteristics of the patients; and (3) the number of patients who were actually benefited and those who were not benefited. And from this review, it is my goal to (1) determine some analysis of costs; (2) suggest patient subgroups who should and should not receive an ICD; and (3) determine the number of patients needed to treat (NNT) to improve survival in 1 patient and how NNT could be reduced.

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