ICD Reimbursement
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description
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
Transcript of ICD Reimbursement
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
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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
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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
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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
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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
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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
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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
