Heart Rhythm Society Issues Editorial Commentary on Recent ICD Study
March 24, 2011 — The Heart Rhythm Society has published an editorial commentary, “ICDs: Evidence, Guidelines, and Glitches,” in HeartRhythm Journal, now available online and to be published in the May print edition. The commentary is a response to the study, “Non-Evidence-Based Implantable Cardioverter-Defibrillator Implantations in the United States,” published in the January 5 issue of the Journal of the American Medical Association (JAMA).
Download Editorial Commentary » (PDF, 320K)
The Society previously issued a joint statement with the American College of Cardiology regarding the study, reiterating the importance of research and measurement tools designed to improve patient care.
The message and teachings of the JAMA study indicate that substantial variations exist among hospital ICD implantation strategies. This variation clearly demonstrates an opportunity for improvement in care delivery. The findings are critical for the cardiovascular community and our patients in moving forward our commitment to change practice patterns to deliver higher quality, evidence-based, cost-effective care.
However, there are continuing questions from members and the general public due to this study, which the Society's commentary aims to address. In addition to addressing areas of concern in the study, the editorial reiterates the Society's position that the NCDR® ICD Registry™ has helped heart rhythm specialists reap substantial benefits in understanding and improving clinical practice related to ICD implantation, with much more on the horizon.
HRS acknowledges that there are instances that inappropriate use of ICD implantation is occurring and that it is our responsibility as professional societies to provide measurement tools, such as the ICD Registry, that can help address inappropriate use. With that caveat, the vast majority of implanting physicians are prescribing ICDs with the confidence that they are providing the best care for their patients.
The study authors emphasize that “the ultimate judgment of the care of a particular patient must be made by the physician and the patient in light of all of the circumstances presented by the patient. There are circumstances in which deviations from these guidelines are appropriate.” While guidelines are designed to account for the majority of clinical scenarios, there are clinical challenges in which the guidelines do not address the unique circumstances of a patient’s treatment options which require physicians to utilize their clinical expertise and judgment.
The Society encourages heart rhythm specialists to read the editorial and continue the discussion on how to improve the quality of patient care.
