Touro President Proposes Program to Save Lives, Money by Reducing Defibrillator Implants
The Marino Organization
New York, N.Y. – Twenty of America’s most-prominent cardiologists and medical specialists have crafted an action plan to save lives and potentially hundreds of millions of dollars in healthcare spending associated with the use of implantable cardiac defibrillators to prevent sudden cardiac death.
In an article published in Circulation, the journal of the American Heart Association, “Risk Stratification for Sudden Cardiac Death: A Plan for the Future,” the medical team calls on clinicians, patient advocacy groups, payers, industry and government agencies to unite behind a coordinated, six-step program that would help ensure that only patients who stand to derive benefit from the device receive implants, which can cost as much as $50,000 per procedure.
“In spite of the billions spent each year to implant cardiac defibrillators, the medical community has still not identified an adequately satisfactory method to determine which patients need this device most,” said Dr. Jeffrey J. Goldberger of Northwestern University’s Department of Medicine-Cardiology. “By assembling the right resources, we can devise a risk stratification standard that deploys scarce medical resources wisely, while saving the greatest number of lives.”
The United States spends approximately $2.4 billion a year on defibrillator implants. Dr. Goldberger estimates that a $50-million research initiative could significantly improve the ability to predict risk, thus allowing providers to target implants to the most appropriate recipients.
Implantable cardioverter-defibrillators are pacemaker-like medical devices that can blunt the often-fatal effects of ventricular fibrillation, a change in heart rhythm that can trigger sudden cardiac arrest.
“Our healthcare system stands to reap massive cost savings by better identifying patients who will gain the most from this life-saving but expensive process,” said Dr. Alan Kadish, a cardiologist who also serves as president and CEO of the Touro College and University System. “America wants to make health care more affordable, and we are confident that our team has devised a smart and practical way to help achieve this goal.”
Dr. Goldberger, Dr. Kadish and the other authors note that heart disease is the leading cause of death in the United States. It is responsible for more than 600,000 deaths annually, according to the National Center for Health Statistics.
Approximately half of these deaths are estimated to be sudden, and about half of this number represents a victim’s first recognized cardiac event. Only a minority of those suffering out-of-hospital cardiac arrest will ultimately survive. Although the incidence of ventricular fibrillation as a cause of out-of-hospital cardiac arrest has been declining, it remains a leading cause of sudden death.
Implantable cardioverter-defibrillators have emerged as an effective but costly therapy. Researchers concur, however, that current guidelines for determining who is most likely to benefit from an implant, could be significantly improved. Under current prediction protocols, the medical community agrees that implants as a whole are not systematically reaching a significant number of patients who may benefit from the device’s ability to provide a life-saving shock to the heart of a patient who experiences sudden cardiac arrest.
Through use of more-accurate risk stratification techniques, more lives could be saved, while at the same time conserving medical resources for cases in which the device is most effective.
Dr. Goldberger, Dr. Kadish and their team call for implementation of a six-step action plan to improve risk predictors. The plan’s elements include establishment of baseline risk models for key patient groups, compiling and assessing current risk stratification techniques, evaluation of emerging risk marker strategies, use of randomized clinical trials, boosting the efficiency of data collection, and creating a process for promoting properly funded, clinical trials that are socially supported by all stakeholders.
“Our goal is to deploy an expensive treatment in the best possible way,” said Dr. Goldberger. “We need to offer this life-saving device to those who will benefit from it. And if we undertake this six-step program correctly in terms of planning, organization and funding, we will have an opportunity to truly deliver better care at a lower cost.”
“Once implemented, this action plan could save hundreds of millions of dollars, and yet the amount of money the Affordable Care Act allocates for this and similar projects is embarrassingly small,” said Dr. Kadish. “America needs to invest a great deal more into research that will show which treatments are beneficial, and which are extraneous.”
Dr. Jeffrey J. Goldberger is a professor in the Medicine-Cardiology Department at Northwestern University’s Feinberg School of Medicine in Chicago and is also affiliated with Northwestern Medical Hospital. He has published more than 180 peer-reviewed papers.
In addition to serving as president and CEO of the Touro College and University System, Dr. Alan H. Kadish’s career in cardiology has included publication of more than 250 peer-reviewed papers.
The Touro College and University System is the largest Jewish-sponsored educational institution in the United States. The system encompasses more than 19,000 students across 32 schools in five countries. Touro provides educational opportunities and career paths ranging from health sciences to liberal arts, and from law to technology, business, Jewish studies, education and other disciplines.