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Cost-Effectiveness of ICD Therapy in the Prevention of Sudden Death in CAD and/or HF Patients

  • Andrea Pozzolini
Conference paper

Abstract

Sudden cardiac death (SCD) is one of the most common causes of death in Western countries [1, 2], and its prevention poses a major challenge to both policymakers and health-care providers. The fundamental principle of evidence-based medicine is that clinical practice should rest on a sound scientific foundation established by clinical studies involving human subjects. The strategies of primary and secondary prevention of SCD with the implantable cardioverter defibrillator (ICD) have received increased attention in the last few years, mainly because multiple prospective randomized clinical trials (RCT) [3, 4] have yielded concordant and consistent results showing that ICD therapy is highly effective in reducing SCD and all-cause mortality in selected patients with impaired left ventricular function on optimized medical treatment (OMT), including post-MI patients as well as patients with nonischemic cardiomyopathy. It is now known that in such patients ICDs reduce mortality by approximately one-third over and above OMT [3]–[8]. Faced with this evidence, recently updated practice guidelines [9]–[11] have suggested a broadening of the indications for prophylactic ICD use; but opinions diverge on the desirability for expansion of this expensive therapeutic strategy, whose widespread implementation threatens to impact heavily on public health-care spending. Thus nowadays, due to the high cost of ICDs and the large population of patients potentially eligible to receive them, the debate on ICDs has moved from issues of feasibility and effectiveness to questions about costs and cost-effectiveness.

Keywords

Sudden Cardiac Death Cardiac Resynchronization Therapy Implantable Cardioverter Defibrillator Therapy Implantable Cardioverter Defibrillator Implantation Multicenter Automatic Defibrillator Implantation Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Andrea Pozzolini
    • 1
  1. 1.Cardiology Operative UnitSanta Croce HospitalFano (PU)Italy

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