| The automatic implantable defibrillator is the most realistic and cost-effective way of preventing sudden cardiac death. | |
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MedLine Citation:
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PMID: 1449454 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Judgement about cost-effectiveness of medical treatments depends upon the criteria used to define effectiveness. The most rational single criterion is the Quality Adjusted Life Year gained (QALY). Comparisons of cost-effectiveness of treatments may be made by comparing the dollar costs per QALY. Both the dollar and the QALY comparisons are subject to all errors of biological variable measurement and bias introduced by experimental design seen in other biological experiments. The proper methodology for comparison is the prospective randomised controlled clinical trial. Such trials using the automatic implantable defibrillator (AICD) as prophylaxis against sudden cardiac death (SCD) have not yet been performed. The major underlying cause of SCD is coronary artery disease with previous myocardial infarction (MI) and provocative tests for ventricular arrhythmias are the most powerful predictors of SCD in infarction survivors. AICD implantation carriers a mortality of about 2%, and survival after successful implantation is about 89% at one, and 84% at two years. By comparison, infarction survivors with left ventricular ejection fraction < 0.4 and inducible slow monomorphic ventricular tachycardia have a survival rate of 70% at one, and 54% at two years. Antiarrhythmic drugs have not proven effective. There is an urgent need to confirm the advantage of the AICD by proper randomised controlled trial. |
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Authors:
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J F Uther |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Australian and New Zealand journal of medicine Volume: 22 ISSN: 0004-8291 ISO Abbreviation: Aust N Z J Med Publication Date: 1992 Oct |
Date Detail:
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Created Date: 1992-12-30 Completed Date: 1992-12-30 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 1264322 Medline TA: Aust N Z J Med Country: AUSTRALIA |
Other Details:
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Languages: eng Pagination: 636-8 Citation Subset: IM |
Affiliation:
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Faculty of Medicine, University of Sydney, NSW, Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Australia Cost-Benefit Analysis Death, Sudden, Cardiac / prevention & control* Defibrillators, Implantable* / economics Health Care Rationing Humans Quality of Life |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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