25% Overuse of Implantable Cardioverter (ICD)

As noted in JAMA, implantable cardioverters are being overused. 25% of patients in the study cited did not have the accepted indications for this expensive procedure. Furthermore:

Patients who received a non–evidence-based ICD compared with those who received an evidence-based ICD had a significantly higher risk of in-hospital death (0.57% [95% confidence interval {CI}, 0.48%-0.66%] vs 0.18% [95% CI, 0.15%-0.20%]; P <.001) and any postprocedure complication (3.23% [95% CI, 3.01%-3.45%] vs 2.41% [95% CI, 2.31%-2.51%]; P <.001).

Medicynical Note: We think of the art of medicine as making treatment decisions using science as well as instincts based on the provider’s unique knowledge of the patient, local standards and what is medically indicated.

In the JAMA study 25% of patients received ICD’s did not have the established indications for the procedure and as a group these patients had worse outcomes. Presumably their doctors felt the use of the ICD indicated (applying the “art of medicine”). As costs have increased (an ICD procedure is $50,000 or more) and better tracking of outcomes reveal that overuse leads to more complications and worse outcomes, I’m not sure we can afford this type artistry.

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