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April 20, 2011, Vol 305, No. 15 >

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Letters | April 20, 2011

ICD Implantation and Evidence-Based Patient Selection

Kathleen Blake, MD; Charles D. Swerdlow, MD
JAMA. 2011;305(15):1537-1540. doi:10.1001/jama.2011.457.
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To the Editor: The study by Dr Al-Khatib and colleagues1 reported that 22.5% of primary prevention ICD implants in the United States do not meet evidence-based guidelines. It has been interpreted to mean that these implants were unnecessary.2

Translation of medical research into care of individual patients is an imperfect science.3 Practice guidelines are an important starting point for clinical decision making, but they are not a substitute for clinical judgment, which can provide independent value.4 The National Cardiovascular Data Registry (NCDR) ICD Registry analyzed by the authors is not designed to determine the medical necessity of ICD implants that do not meet evidence-based guidelines.

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April 20, 2011
ICD Implantation and Evidence-Based Patient Selection
Michael H. Lehmann, MD
JAMA. 2011;305(15):1537-1540. doi:10.1001/jama.2011.459.
April 20, 2011
ICD Implantation and Evidence-Based Patient Selection—Reply
Alan Kadish, MD; Jeffrey J. Goldberger, MD
JAMA. 2011;305(15):1537-1540. doi:10.1001/jama.2011.461.
April 20, 2011
ICD Implantation and Evidence-Based Patient Selection
Jeanne E. Poole, MD; Dan Fishbein, MD; George H. Crossley, MD
JAMA. 2011;305(15):1537-1540. doi:10.1001/jama.2011.456.
April 20, 2011
ICD Implantation and Evidence-Based Patient Selection
Steven Zweibel, MD; Christopher Clyne, MD; Eric Crespo, MD, MPH
JAMA. 2011;305(15):1537-1540. doi:10.1001/jama.2011.458.
April 20, 2011
ICD Implantation and Evidence-Based Patient Selection—Reply
Sana M. Al-Khatib, MD, MHS; Daniel Mark, MD, MPH; Stephen Hammill, MD
JAMA. 2011;305(15):1537-1540. doi:10.1001/jama.2011.460.
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