Study confirms ICDs more effective in preventing sudden cardiac death than medical therapies

Northwestern Memorial cardiologist authors editorial in January 20 edition of New England Journal of Medicine

Alan Kadish, M.D., associate chief of Cardiology at Northwestern Memorial Hospital and associate director of the Northwestern Cardiovascular Institute, authors an editorial entitled “Prophylactic Defibrillator Implantation – Toward Evidence-Based Approach,” which accompanies the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) reported in the January 20 edition of the New England Journal of Medicine.

“This is the second large-scale study to suggest that heart failure patients without coronary artery disease who receive ICDs, implantable cardioverter-defibrillators, have a better outcome than those treated with medical therapies,” according the Dr. Kadish. “This study confirms the effectiveness of ICDs in preventing sudden cardiac death.”

Dr. Kadish was an investigator on the only other large study previously done to examine the ability of ICDs to decrease mortality among patients with heart failure. The Defibrillators in NonIschemic Cardiomyopathy Treatment Evaluation (DEFINITE) showed a relative 35 percent decrease in overall mortality with the use of ICD therapy. In SCD-HeFT, there was a 27 percent relative decrease in mortality among these patients. The results of these two studies are broadly consistent.

“While ICDs are expensive, results of this trial, combined with those of DEFINITE show that they are indeed cost-effective when used in the appropriate population,” explains Dr. Kadish. “Patients with an ejection fraction – the percentage of blood that is pumped out of a filled ventricle with each heartbeat – of less than 31 percent should be considered for a single-chamber ICD. Patients with an ejection fraction of 31 to 40 percent pose a more difficult treatment challenge, and these patients will require additional testing and evaluation to determine whether a prophylactic ICD would be beneficial. The results of studies completed in the last year will increase the number of patients who can benefit from life-saving therapy with an ICD.”

More research will need to be done to determine if the benefit of the ICD is more marked in patients with less severe congestive heart failure.

About Northwestern Memorial Hospital

Northwestern Memorial Hospital (NMH) is one of the country’s premier academic medical centers and is the primary teaching hospital of Northwestern University’s Feinberg School of Medicine. Northwestern Memorial and its Prentice Women’s Hospital and Stone Institute of Psychiatry have 744 beds and more than 1,200 affiliated physicians and 5,000 employees. Providing state-of-the-art care, NMH is recognized for its outstanding clinical and surgical advancements in such areas as cardiothoracic and vascular care, gastroenterology, neurology and neurosurgery, oncology, organ and bone marrow transplantation, and women’s health.

Northwestern Memorial was ranked as the nation’s 5th best hospital by the 2002 Consumer Checkbook survey of the nation’s physicians and is listed in eight specialties in this year’s US News & World Report’s issue of “America’s Best Hospitals.” NMH is also cited as one of the “100 Best Companies for Working Mothers” by Working Mother magazine and has been chosen by Chicagoans year after year as their “most preferred hospital” in National Research Corporation’s annual survey.

About the Northwestern Cardiovascular Institute

The NCVI is a world-class heart program offering comprehensive services and state-of-the-art surgical treatments in all areas of cardiovascular care. Patients treated at Northwestern Memorial Hospital benefit from a timely response to referrals and a multidisciplinary approach that joins physicians, nurses and a range of other medical specialists and caregivers from Cardiology, Cardiac Surgery, Vascular Surgery, Cardiovascular Anesthesiology and Radiology from evaluation to follow-up. Patients benefit from the latest minimally invasive surgical techniques and are offered the opportunity to participate in a range of clinical research trials.

Advanced Cardiovascular Care

Patients referred to the Northwestern Cardiovascular Institute experience a healthcare environment in which the most advanced diagnostic and treatment options are supported by state-of-the-art technology and a commitment to medical excellence through research. Expertise is available in all areas of cardiovascular care, including:

Cardiac Surgery

• Valve repair and replacement
• MAZE and atrial fibrillation ablation procedures
• Coronary artery bypass with arterial conduits
• LV and aortic aneurysm repair
• Congestive heart failure surgery
• Ventricular assist devices

Vascular Surgery

• Thoracic and abdominal aortic aneurysm surgery
• Carotid endarterectomy and stents
• Endovascular surgery for aortic aneurysms and limb salvage
• Lower extremity bypass procedures
• Uncommon mesenteric and upper extremity revascularization
• Supraaortic trunk revascularization

Cardiology

• Primary and secondary prevention
• Advanced diagnostic testing including echocardiography, nuclear cardiology, cardiac MRI and computed tomography
• Cardiac electrophysiology, including diagnostic EP procedures, catheter ablation and pacemaker and ICD implantation
• Heart failure management
• Evaluation of heart valve disease
• Acute coronary care
• Diagnostic catheterization and interventional cardiology