by
Lauren Dubinsky, Senior Reporter | May 24, 2016
From the May 2016 issue of HealthCare Business News magazine
Biederman and his team evaluated 157 patients who were placed in one of three implantable cardiac device case groups. There were 114 patients put into the neurological group, 36 in the cardiovascular group and seven in the musculoskeletal group. In 88 percent of the neurology cases, the MR provided value for the final diagnoses, and in 18 percent of the cases the MR exam altered the diagnoses entirely. For the cardiac and musculoskeletal cases, the extra value percentage was even higher at 92 and 100 percent, respectively.
“There was a marked incremental value to perform the MR,” says Biederman. “We knew that just because we could do the MR, didn’t mean it was the right thing to do. In this case, however, we redirected appropriate care in a high-risk population comprising patients with neurosurgical, orthopedic and cardiac pathologies.” In late March, Biederman was referred to a patient at AGH who was believed to have had cardiac sarcoidosis for 15 years. One of the cardiologists at the hospital decided to have the patient, who had an ICD, undergo an MR exam, so they imaged his heart and found that he didn’t have the condition.
“In most cases, that information couldn’t be obtained with cardiac catheterization, echo or nuclear, so the MR added real value. Additionally, the patient did not have to have an open heart procedure or a biopsy of the heart muscle and [have the patient face] all of the attendant risks,” says Biederman.
Longer battery lives needed
The lithium battery in ICDs can last up to seven years, according to the Mayo Clinic. But an article published by the academic research website British Medical Journal in February stated that battery life needs to be extended to 25 years or more to avoid the risks associated with replacement. The risk of infection associated with replacing ICD batteries ranges from 1 to 5 percent, but that may be incorrect because there is no standard definition for what an infection is.
Dr. John Dean, a consultant cardiologist at Royal Devon and Exeter Hospital in the U.K., explained in the BMJ article that it’s important to minimize the amount of surgical interventions patients undergo because of the risk of complications and infections. Dean points out, however, that the current financial model discourages the development of longer life devices. “With financial disincentives for both manufacturers and purchasers it is hardly surprising that longer life devices do not exist,” he says.
For the purchaser, that disincentive would be a much higher initial price for a device that lasts 25 years. It’s also assumed that patients want smaller devices even though a study published in the journal Pacing and Clinical Electrophysiology in 2004 found that 90 percent of patients would prefer larger devices if they last longer. The authors of the study also reported that ICDs are usually replaced when they are still able to deliver at least six full energy shocks, which could equate to at least another six months of useful battery life. But the authors did caution that early replacement may be necessary for patients at high risk of cardiac problems.
