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ICD Reimbursement. ICD Reimbursement. ICD Reimbursement. ICD Reimbursement. ICD Reimbursement. ICD Reimbursement. ICD Reimbursement. Mortality by Intention-to-Treat. Mortality. 36.1% 7.2% year. Months of follow-up. Mortality. Months of follow-up. Mortality by Intention-to-Treat. - PowerPoint PPT Presentation
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ICD ReimbursementICD Reimbursement
ICD ReimbursementICD Reimbursement
ICD ReimbursementICD Reimbursement
ICD ReimbursementICD Reimbursement
ICD ReimbursementICD Reimbursement
ICD ReimbursementICD Reimbursement
ICD ReimbursementICD Reimbursement
Mortality by Intention-to-Mortality by Intention-to-TreatTreatMortalityMortality
Months of follow-upMonths of follow-up
36.1%36.1%7.2% year7.2% year
0
0.1
0.2
0.3
0.4
0 6 12 18 24 30 36 42 48 54 60
AmiodaroneICD TherapyPlacebo
• Median follow-up: 45.5 mo (34.8, 55.2)• Vital status known on 100% of 2,521 patients
0
0.1
0.2
0.3
0.4
0 6 12 18 24 30 36 42 48 54 60
Mortality by Intention-to-Mortality by Intention-to-TreatTreat
MortalityMortality
Months of follow-upMonths of follow-up
0
0.1
0.2
0.3
0.4
0 6 12 18 24 30 36 42 48 54 60
AmiodaroneICD TherapyPlacebo
HR 97.5% CI P-ValueAmiodarone vs. placebo 1.06 0.86, 1.30 0.529
0
0.1
0.2
0.3
0.4
0 6 12 18 24 30 36 42 48 54 60
Mortality by Intention-to-Mortality by Intention-to-TreatTreat
MortalityMortality
Months of follow-upMonths of follow-up
0
0.1
0.2
0.3
0.4
0 6 12 18 24 30 36 42 48 54 60
AmiodaroneICD TherapyPlacebo
HR 97.5% CI P-ValueAmiodarone vs. placebo 1.06 0.86,1.30 0.529ICD Therapy vs. Placebo 0.77 0.62, 0.96 0.007
0
0.1
0.2
0.3
0.4
0 6 12 18 24 30 36 42 48 54 60
DEFINITE Mortality – NYHA FC III
No. at RiskNo. at RiskStandard 35 Standard 35 18 18 8 8 3 3 ICD ICD 38 38 23 23 11 11 3 3
Survival Time in YearsSurvival Time in Years554433221100
.9.9
.8.8
.7.7
.6.6
.5.5
ICDICD
StandardStandard
Pro
bab
ilit
y of
Su
rviv
alP
rob
abil
ity
of S
urv
ival
1.01.0
p=0.009; RR=0.33p=0.009; RR=0.33
STD=16/49 (33%)STD=16/49 (33%)ICD= 6/47 (13%)ICD= 6/47 (13%)
ICD WorkupICD Workup
•LVEF ≤ 35%•NYHA FC•QRS Duration (120 ms)•Ischemic or nonischemic Cardiomyopathy
•Duration of NIDCM •(3 vs 9 months)
•Time since last Myocardial Infarction•40 days
•Time since last PCI or CABG•3 months
ICD WorkupICD Workup
•Echo•40 days from MI•3 months from PCI or CABG•Dyssynchrony if QRS < 120 ms
•NYHA FC• On Beta Blockers & ACE Inibitor
•QRS Duration (120 ms)•No ongoing need for revascularization
Scheduling ICD ImplantScheduling ICD Implant• After CABG or PCI
• 3 month return, D/C on Beta Blocker & ACE• 2D echo, ECG• EP consult• ICD or BiV ICD prescheduled
• Determined by NYHA and FC• After MI
• 40 day return , D/C on Beta Blocker & ACE• 2D echo, ECG• EP consult• ICD or BiV ICD prescheduled
• Determined by NYHA and FC
Scheduling ICD ImplantScheduling ICD Implant• After NIDCM Diagnosis – plan IRB Trial
• 3 month return, D/C on Beta Blocker & ACE• 2D echo, ECG• EP consult• ICD or BiV ICD prescheduled
• Determined by NYHA and FC• After NIDCM Diagnosis – No planned IRB Trial
• 9 month return, D/C on Beta Blocker & ACE• 2D echo, ECG• EP consult• ICD or BiV ICD prescheduled
• Determined by NYHA and FC
