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Not all patients will need a replacement ICD
Do all ICD patients need a new device when the battery gets low?
Should everyone with an internal defibrillator (ICD) automatically get a new generator when the device's power reserves are getting low?
Not necessarily, according to a Perspective in the January 26, 2012 issue of the New England Journal of Medicine.
From the patient and society perspectives, the expense and uncertainty of ICD therapy argue for a more considered and nuanced approach to ICD replacement," say the authors, led by Dr Daniel B Kramer from the Beth Israel Deaconess Medical Centre in Boston, America.
"Evaluation of the clinical and ethical aspects of ICD replacement is long overdue," he said.
The team propose:
- Clinical re-evaluation of patients – their health may have changed. For example, their ejection fraction (volume of blood pumped out of the heart with each beat) and clinical outlook might have improved
- A re-evaluation of patients’ wishes - their experiences of living with their devices may have changed their views
Dr Kramer also warned against barriers to implementing such changes, including:
- A patient’s care being spread among different doctors with no single doctor being responsible for identifying reasons for re-evaluation
- Funding and referral issues that might encourage doctors to keep up the numbers of their patients with ICDs
Dr Kramer added: "Untold numbers of patients will continue to receive devices whose implantation they might reasonably want to defer if the system were more rationally designed to support decision-making.
"We propose that doctors who implant ICDs take the lead in engaging and educating primary-care doctors, general cardiologists, and other specialists regarding the appropriateness of ICD replacement for individual patients."
by CMA Manager on 30-Jan-12 16:06
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