Yale researchers investigate decline in use of preventive defibrillators
In some patients with weak heart muscles, an implantable cardioverter defibrillator, or ICD, can help maintain normal heart rhythm and prolong life. However, concerns about possible overuse of these devices, and a federal investigation, may have led to a recent drop in their use by doctors, a Yale-led study found.
Led by associate professor of medicine Jeptha Curtis, the research team analyzed data from a national registry of ICDs before and after the launch of an investigation by the Department of Justice. That investigation was triggered by a lawsuit alleging overuse of ICDs in patients who did not meet national, evidence-based criteria. The researchers’ analysis found that in the period following the announcement of the investigation in 2010, the proportion of ICDs placed that didn’t meet evidence-based criteria fell by more than 50%. That was true in all hospitals studied, though reductions were substantially larger at hospitals that reached settlements in the investigation, and for all patients, including those who have Medicare insurance as well as those with other forms of insurance.
The findings show that the DOJ investigation was associated with a significant reduction in implanted devices that did not meet the Centers for Medicare and Medicaid Services National Coverage Determination, the researchers said. But questions remain, including whether the investigation may have also caused providers to avoid implanting the devices in patients who need them. Read the full paper, co-authored by Nihar Desai, in JAMA.