SURGEONS are increasingly implanting tiny devices into heart disease patients which shock the heart and prevent sudden cardiac death.
According to research published in the Medical Journal of Australia the number of implantable cardioverter defibrillator (ICD) procedures increased from 1844 in 2002–03 to 6504 in 2014–15 More than 75% of procedures were in men.
The annual cost of the treatment is around $155 million.
An Australian-first study has analysed data from the National Hospital Morbidity Database to determine the number of ICD procedures by year, patient age and sex, and to estimate age group-specific population rates and associated costs.
Dr Jodie Ingles, Head of the Clinical Cardiac Genetics Group at the Centenary Institute and lead researcher wrote: “In 2014–15, the ICD insertion rate for people aged 70 or more was 78.1 per 100,000 population, 22 per 100,000 for those aged 35–69 years, and 1.40 per 100,000 people under 35.”
“It is unclear whether the overall increase in procedure rates reflected an increasing need for ICD therapy, or was a direct result of increased awareness of risk factors for sudden death,” Dr Ingles and colleagues wrote.
“A patient-centred approach to care, including discussing the benefits and risks of ICD therapy with the patient and their family, is essential. The proportion of women among patients undergoing ICD procedures is relatively small (about 20%).
The authors were surprised by one set of results in particular – the increased rate of ICD removals.
“The most frequent reasons for ICD removal are post-surgical infection (clinically accepted infection rate: 1%), device malfunction, misdiagnosis of a heart condition, or lack of clinical benefit,” they wrote.
The researchers believe the high rate of removals of ICDs and the possibility that ICD therapy is underused in female patients should be investigated.
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