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Have pacemakers found their way into too many patients?

William A. Check
JAMA. 1980;243(23):2371-2372. doi:10.1001/jama.1980.03300490003001.
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A group of Brooklyn, NY, cardiologists has evidence that a nonbinding peer review system can reverse the dramatic expansion of an expensive technology—pacemaker implantation.

The financial impact of such a retrenchment is potentially quite large, concluded Howard S. Friedman, MD, chief of cardiology at The Brooklyn Hospital, in his presentation at the recent meeting of the American Federation for Clinical Research in Washington, DC.

"If this result can be extrapolated nationally, the health care cost due to pacemaker implantation can be reduced by several hundred million dollars per year," he said.

Friedman explained that this estimate is based on a total first-year cost for pacemaker implantation of approximately $5,000.

Several members of the audience praised the study but raised questions about patients who did not receive pacemakers subsequent to formation of the peer review committee. "What have you done to the survival of those who would have received the pacemaker


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