Expanding indications for defibrillators after myocardial infarction: risk stratification and cost effectiveness.

摘要: Practice guidelines have expanded to include a new Class IIa recommendation for implantable cardiac defibrillator (ICD) use in patients post-myocardial infarction (MI) with left ventricular ejection fraction (LVEF) ≤30% on the basis of results Multicenter Automatic Defibrillator Implantation Trial II (MADIT II). Given that over 3 million North America meet these criteria and 400,000 additional will every year, potential costs healthcare system are substantial possibly prohibitive. The MADIT must be interpreted context other studies. benefits ICD therapy may vary substantially across subgroups patients. Studies amiodarone suggest it useful if used addition beta-blockers, relative value this compared remains elucidated. Subgroups QRS duration >0.12 seconds or LVEF ≤25% appear derive greatest benefit from therapy. Cost-effectiveness depends magnitude expected differ different levels risk. Better risk stratification strategies needed predict which most. Results ongoing studies crucial determining effectiveness optimal medical including beta-blockers. Predictors subsets most likely urgently order prioritize allocation resources.