Pham Quoc Khanh ICD bao cao

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PRIMARY RESULTS OF ICD FOR

PREVENTION OF SCD

IN VIETNAM HEART INSTITUTE

PHAM QUOC KHANH, MD, PhD et al

Vietnam heart Institute

• ICD worldwide implants have grown an average of 24% per

year in the last five years.

• There is substantial variation in ICD use by country.

• The U.S claims-based study attempts to quantify the

number of patients who qualify for ICD therapy.

U.S Bureau:World population profile 2000.www.census.gov,2001.

Am J Cardiol 1997;80(5B):10F-19F.

InstructorÕs Guide to ICDs 2000, Morgan Stanley, Dean Witter.

JCE 2002;13:38-43.

Background

• ICDs greatly reduce the incidence of sudden cardiac

death among patients with life threatening ventricular

tachyarrhythmias and recently have been proven to

reduce all cause mortality in these patients

• Although ICD therapy is very effective, it is perceived as a

more expensive therapy than antiarrhythmic drug therapy

• High healthcare costs are a concern to both healthcare

insurers and the medical community

• Accounts for 63% of all cardiac related deaths in the

US 1

• One of the most common causes of death in

developed countries:

1MMWR Vol 51(6) Feb 15, 2002.

2 Myerberg RJ, Catellanos A Cardiac Arrest and Sudden Cardiac Death In: Braunwald E, ed Heart Disease: A Textbook

of Cardiovascular Medicine 5th Ed New York: WB Saunders 1997: 742-779.

3 Circulation 2001;104:2158-2163.

4Vreede-Swagemakers JJ et al J Am Coll Cardiol 1997; 30: 1500-1505.

Sudden Cardiac Arrest (SCA) Statistics

Geography Incidence Survival

Worldwide 3,000,0002 <1%2

W Europe 400,0004 <5%4

myocardial infarction and heart failure.2

Magnitude of SCA in the US

1Circulation 2001;104:2158-2163.

1 To evaluate the effect of ICD for the primary and secondary Prevention of Sudden cardiac death

2 To study the applicability of this therapy for the clinical practice in Vietnam

objectives

MATERIALS AND METHOD

Patient Inclusion Criteria

• VT/VF patients identified by four diagnostic codes (primary or secondary):

EPS on Brugada syndrome

 18 patients:

+ Biochemical test: normal

+ Blood test: Normal.

CLINICAL FINDINGS

Patients

(n=18)

Events (pts)

No(pts)

Syncope 14

2,3  1,9(1 – 8)

4

Cardiac

arrest

(pts)

Number 7

1,6  0,8( 1 – 3 )

11

1The AVID Investigators N Engl J Med 1997;337:1576-1583.

2 Kuck K ACC98 News Online April, 1998 Press release.

3Connolly S Circulation 2000;101:1297-1302

4Moss AJ N Engl J Med 1996;335:1933-1940.

5Buxton AE N Engl J Med 1999;341:1882-1890.

1Moss AJ N Engl J Med 1996;335:1933-40.

2Buxton AE N Engl J Med 1999;341:1882-90.

3Moss AJ N Engl J Med 2002;346:877-83

4 Moss AJ Presented before ACC 51st Annual Scientific Sessions, Late Breaking Clinical Trials, March 19, 2002.

5The AVID Investigators N Engl J Med 1997;337:1576-83.

6Kuck K Circ 2000;102:748-54.

7 Connolly S Circ 2000:101:1297-1302.

ICD mortality reductions in primary prevention trials

are equal to or greater

than those in secondary

Fluoroscopy time (minutes)

Cosuming time(minutes)

Patients (n=18) 17,3  4,8 59,7  11,6

Consuming time and fluoroscopy time in procedures

Case #1

• 57-year-old gentleman

• Smoking for several years

• Hypertension for 2 years, well controlled

• VT with hypotension.

• Coronary angiography: Multivessel stenosis

ECG before ICD

ICD shock

T shock

ICD shock

ICD Cost-Effectiveness

• Overall ICD therapy cost has decreased over time,

but ICDs are expensive, resulting in greater

scrutiny as the number of ICD patients has

increased.

• Conflicting ICD cost-effectiveness results for

secondary prevention indications.

• Positive ICD cost-effectiveness results for post MI

primary prevention indication.

Cost of ICD Therapy

Calculations and references in slide notes.

The cost/day of ICD therapy has dropped dramatically due to reduced procedure costs, reduced LOS (less invasive implant procedure due to pectoral implants/endocardial leads, ) and increased battery life.

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