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New Guidance for ICD Implantation Offers Decision Aids for Physicians and Patients

Mike Mitka, MSJ
JAMA. 2013;309(16):1671-1672. doi:10.1001/jama.2013.3541.
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Key cardiology groups have issued guidance for the appropriate use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy. The February publication follows a federal investigation into ICD implantation and a study suggesting that more than 1 in 5 ICDs is implanted inappropriately.

The guidance establishes criteria that cover 6 areas: ICDs for primary prevention, ICDs for secondary prevention, comorbidities, cardiac resynchronization therapy devices, generator replacements with preexisting cardiovascular implantable electronic devices, and dual- vs single-chamber ICDs (http://tinyurl.com/cstq7p8). The document was developed by the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS) along with key specialty societies, including the American Heart Association (AHA). It is to be used in conjunction with the “ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities” and its 2012 focused update.

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A 2011 study found a high rate of inappropriate use of implantable cardioverter-defibrillators, such as in patients with chronic heart failure of less than 3 months duration or in patients within 40 days of acute myocardial infarction or within 90 days of coronary artery bypass graft surgery.



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