Dear Readers, Dr. Al-Khatib and colleagues recently published a study in the Journal of the American Medical Association that received a great deal of attention.1 The title alone is an attention getter: “Non-evidence-based ICD implantations in the United States.” What exactly, if anything, did this study teach us? The authors used the National Cardiovascular Data Registry-(NCDR) ICD Registry to identify patients who underwent implantable cardioverter defibrillator (ICD) implantation for primary prevention, but did not have an “evidence-based indication.” They excluded patients who received a cardiac resynchronization pacing device. The following criteria were used to identify patients who did not have an evidence-based indication:
- Myocardial infarction (MI) within 40 days before implantation.
- Newly diagnosed heart failure (HF) at the time of ICD implantation.
- New York Heart Association (NYHA) functional class IV symptoms.
- Coronary artery bypass surgery within 3 months.
- A patient with heart failure and an LVEF of 20% who has complete heart block after CABG and valve replacement and needs pacing.
- A patient with severe class IV heart failure and a recently diagnosed dilated cardiomyopathy who is listed from transplantation and the ICD is implanted as a ‘bridge to transplant.’
- A patient admitted with a nonischemic cardiomyopathy and chronic heart failure who is admitted with an acute episode of heart failure and a mild troponin elevation, resulting in a diagnosis of myocardial infarction in the chart.
- Al-Khatib SM, Hellkamp A, Curtis J, et al. Non-evidence-based ICD implantations in the United States. JAMA 2011;305:43-49.