The procedures cost more than $35,000, involve surgery and anesthesia, and may unnecessarily harm some patients. About 100,000 are implanted in the United States, and even former Vice President Dick Cheney received one in 2001.
Physician specialty played a role in the likelihood of off-guideline use. Electro physiologists had significantly lower rates of off-guideline ICD implantation at 20.8% compared with 24.8% for non-electro physiologist cardiologists, 36.1% for thoracic surgeons, and 24.9% for other specialties.
Implanted defibrillators shock the heart back into a normal rhythm when it starts beating irregularly. An implantable cardiac defibrillator (ICD) is a small electronic device installed inside the chest to prevent sudden death from cardiac arrest due to life threatening abnormally fast heart rhythms or tachycardias. The ICD is capable of monitoring the heart rhythm, and when the heart is beating normally, the device remains inactive. If the heart develops a life-threatening tachycardia, the ICD delivers an electrical shock to the heart to terminate the abnormal rhythm and return the heart rhythm to normal.
Dr. Sana Al-Khatib of Duke University School of Medicine in Durham states in today's Journal of the American Medical Association:
"It's lack of knowledge. It's ignorance. It's not keeping track of the guidelines, and we may have some physicians who don't agree with the guidelines or don't think the guidelines apply to their patients. It's all about improving the quality of care."
The researchers found that the patients who got implants, which cost thousands of dollars, are less likely to die in the hospital and suffer complications than the patients whose surgeries clearly fell outside the guidelines.
Dr. Douglas Zipes of the Indiana University School of Medicine in Indianapolis, and who has helped author the ICD usage guidelines in 2008, feels the 22% rate of mis-treatment is extremely high. He noted that doctors with special training in heart rhythms had slightly better rates of evidence-based implants than did other types of doctors in the study.
Zipes simply concludes:
"If the patient is not benefiting, we shouldn't be doing it."