General Facts About Medical Devices

Medical Devices to treat heart rhythm disorders include pacemakers and Implanted Cardioverter Defibrillators (ICD). Pacemakers are devices that use electrical impulses to treat bradycardia, a heart rate that is too slow. ICDs, pacemaker-like devices that are implanted under the skin, are the most successful therapy to prevent sudden cardiac arrest. ICDs continually monitor the heart, and automatically deliver an electric shock if it detects ventricular fibrillation (VF) or ventricular tachycardia (VT), a rapid heart beat in the ventricles that often leads to VF and near-certain death.

• Many studies show that ICDs are effective to reduce mortality. They are most effective for patients who have experienced ventricular fibrillation or tacycardia. In another study, ICD patients who receive an ICD initially pay more because of the cost of the device but pay less in follow-up care than patients treated with medication.¹
• Several studies have shown lower use of cardiac procedures in racial/ethnic minorities. One particular study found that, in a large population of California patients hospitalized for life-threatening ventricular arrhythmia (LTVA), African Americans received significantly fewer invasive electrophysiological studies (EPS) and ICD procedures than Caucasians and had higher mortality rates a year later.²
• A study published in the Journal of the American College of Cardiology shows that African Americans are receiving ICD implants more frequently but still 30 percent less than whites. In the period between 1990 and 1992, African Americans were receiving the implants at 52 percent of the rate of whites. The study shows that between 1999 and 2000, the rate has improved to 69 percent.³
  

¹AHRQ Clinical Highlights: Treatment to Prevent Sudden Cardiac Death.
²AHRQ Research Activities, December 2002: Researchers examine the risk factors for sudden cardiac death and management of at-risk patients. Alexander, M., Baker, L., Clark, C., and others (2002). "Management of ventricular arrhythmias in diverse populations in California." American Heart Journal 144, pp. 431-439.
³"Trends in implantable cardioverter-defibrillator racial disparity: The importance of geography." Journal of the American College of Cardiology, 4 January, 2005, Vol. 45, issue 1, 72-78.