Implantable Defibrillators:

A Cost Effective Way To Prevent
Death From Cardiac Arrest?

What Are Implantable Defibrillators?

Implantable defibrillators are devices used to prevent sudden death in patients with ventricular fibrillation (arrhythmia of the ventricle). One might typically be given to a patient who…

  • Has rapid heartbeats (ventricular tachycardia)
  • Has fibrillations
  • May have suffered a heart attack in the past resulting in damage to the heart.

The device itself has leads (wires) positioned inside the heart that monitor its rhythm. In the event of arrhythmia the heart would receive an electrical shock to reestablish normal activity. 

In some cases implantable defibrillators might be prescribed for patients who do not suffer from arrhythmias but have had a cardiac event (heart attack) damaging the heart.

The damage makes the patient at higher risk for sudden cardiac death even in the absence of normal arrhythmias.

One study reported in the New England Journal of Medicine evaluated the effectiveness of defibrillators in these cases. 

The study included 1,232 patients who had suffered a heart attack and also had an ejection fraction not exceeding 30%. Ejection fraction measures the amount of blood pumped from the heart and is normally between 50 and 75%. Patients in the study were divided into two groups. The first group received defibrillators. The second group received conventional medical treatment.

In the former group there was a 31% reduction in the risk of deathindicating that defibrillators have a bright future in the treatment of similar patients. However, there is a dark cloud dimming the radiance of the silver lining.

The defibrillator group showed a 19.9% worsening heart failure compared to the traditionally treated group at 14.9%.

What does all this mean? It indicates that we don’t know enough yet to prescribe defibrillators for everyone in the group described above. The first step is to narrow in on the type of patent that would benefit most from implantable defibrillators while keeping the risks and costs low.

What About The Cost?

As one might imagine the cost of implantable defibrillators is not low. But to get a better feel for how expensive they are certain factors must be considered.

Assuming that in many cases implantable defibrillators are promising as a superior treatment for the prevention of sudden cardiac death it is important to determine if their cost puts them beyond the means of most people. A recent study was aimed at answering this and similar questions. 

The study was restricted to treatment of patients who had had life-threatening arrhythmias and were at risk for subsequent events. In order to determine comparative costs the researchers considered both actual costs and life gained for the use of an implantable cardioverter defibrillator (ICD) compared to antiarrythmia drug treatment. 

The test group totaled 1,008 including 505 patients with an ICD. The researchers gathered data on charges for…

  • Initial and repeat hospitalizations
  • ER visits
  • Day surgery stays
  • Antiarrhytmic drugs
  • ICD

Charges including all other medical expenses including outpatient services and prescription costs were recorded for a subset of 237 patients. 

The largest expense for patients of both groups involved inpatient care totaling 73% of total costs for the drug treatment group and 84% for patients with defibrillators. At the three-year mark in the study the total cost for patients in the drug treatment group came to $71,421. The total cost for the ICD patients was $85,552.

However the latter group showed a better survival rate (0.21-year average survival benefit).

The researchers calculated this benefit into the raw numbers deriving a 'per year of life saved' quotient. This brought the cost-effectiveness of the ICD group to $66,677 per year of life saved making it more cost effective than treatment only involving drug therapy.

The conclusion is that treatment involving defibrillators is more expensive but patients receiving such treatment live longer. Traditionally doctors have thought that $50,000 per year of life saved is a bargain. ICD treatment is marginally close to that figure. 

The bottom line is costs are high for ICD treatment as well as tradition drug treatment. Doctors continue to stress to their patients, as does the American Heart Association, that high-tech (and therefore high cost) solutions to heart problems would be less needed if people would be more serious about low-tech prevention. Such as…

  • Smoking cessation
  • Getting proper exercise
  • Eating a heart healthy diet
  • Taking quality dietary supplements

These actions will go a long way to maintaining and restoring a healthy cardiovascular system.

Heart Healthy Diet 

Fish Oils and Omega 3 

Dietary Supplements 

Return from Defibrillators page to Sudden Cardiac Death page.

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