Quest for the Best Candidate
| Autor: | Ole-Alexander Breithardt, Giinter Breithardt |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
genetic structures Pharmacological therapy business.industry medicine.medical_treatment Cardiac resynchronization therapy Implantable defibrillator medicine.disease Individual risk Sudden death Pharmacological treatment Physiology (medical) Heart failure Internal medicine cardiovascular system medicine Cardiology cardiovascular diseases Cardiology and Cardiovascular Medicine Ventricular dyssynchrony business circulatory and respiratory physiology |
| Zdroj: | Circulation. 113:926-928 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circulationaha.105.607366 |
| Popis: | Within the last decade, cardiac resynchronization therapy (CRT) has evolved rapidly and is today widely accepted as a class I indication for selected patients with heart failure.1,2 It is generally recommended for patients with advanced systolic heart failure who are symptomatic despite optimized pharmacological treatment and who show evidence of ventricular dyssynchrony, usually diagnosed by a prolongation of the QRS width above 120 to 130 ms. Devices that combine biventricular pacing with an implantable defibrillator (CRT-D) have demonstrated a significant reduction in arrhythmic death in a high-risk population.3,4 The more recently published results from the Cardiac Resynchronization-Heart Failure (CARE-HF) trial showed a significant survival benefit for such selected patients who were treated with a biventricular CRT pacemaker device (CRT-P) without defibrillator backup.5 These beneficial CRT effects in addition to optimized pharmacological therapy result in a strikingly reduced need for heart failure–related hospitalization and make CRT-P clearly a cost-effective therapy, with an incremental cost-effectiveness ratio of less than &$25.000 per quality-adjusted life-year gained.6–8 At present, however, the majority of implanted systems in the United States and in Western Europe are CRT-D devices, which, in comparison to CRT-P, offer only a comparatively modest additional survival benefit in relation to their incremental costs.9 Therefore, these CRT-D devices must currently be regarded as less cost-effective than CRT-P, and there is an ongoing debate as to whether every patient qualifying for CRT should receive a CRT-D device.10,11 From a cardiologist’s point of view, the decision about the need for a defibrillator backup should only be based on a careful assessment of the individual risk for sudden death and each patient’s (estimated) individual survival benefit and not by our concerns about general healthcare expenditures. If we want to keep the freedom to prescribe the best treatment for each patient, however, … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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