AI Article Synopsis
- The study examined the impact of newly expanded CMS coverage for implantable cardioverter-defibrillators (ICDs) on patients with nonischemic dilated cardiomyopathy, specifically looking at two groups: those diagnosed for less than 9 months and those diagnosed for 9 months or longer.
- Researchers analyzed arrhythmic events and mortality in 131 patients, finding no significant difference in the occurrence of ventricular arrhythmias between the newly diagnosed group and those diagnosed later.
- The conclusion suggests that the 9-month distinction in CMS guidelines may not effectively identify patients at high risk for sudden cardiac death in this context.
Article Abstract
Background: The Centers for Medicare and Medicaid Services (CMS) recently expanded coverage for implantable cardioverter-defibrillators (ICDs) in patients with left ventricular ejection fraction < or =35% and nonischemic dilated cardiomyopathy for > or =9 months. To investigate the ramifications of these criteria, the ICD registry from Tufts-New England Medical Center was analyzed for arrhythmic events and death in patients with newly diagnosed (<9 months) vs late-diagnosed (> or =9 months) nonischemic dilated cardiomyopathy.
Objectives: The purpose of this study was to analyze the arrhythmic risk in patients with recent vs late diagnosis of nonischemic dilated cardiomyopathy.
Methods: One hundred thirty-one patients with nonischemic dilated cardiomyopathy were divided into two cohorts (<9 or > or =9 months of symptoms) and analyzed for any occurrence of treated ventricular arrhythmia, potentially lethal arrhythmias defined as ventricular flutter rates > or =230 bpm, and ventricular fibrillation. Patients with documented sustained ventricular tachycardias (included in prior CMS coverage) were excluded.
Results: In the study group, the mean age was 58.1 +/- 15 years and ejection fraction 20.6% +/- 8%. In a follow-up period of 25.3 +/- 24 months, the 52 patients with a recent diagnosis (1.4 +/- 2 months) had no difference in the occurrence of ventricular arrhythmias (P = .49) and malignant ventricular arrhythmias (P = .16) compared with the 79 patients diagnosed > or =9 months (mean 58.1 +/- 39 months).
Conclusion: Patients with nonischemic dilated cardiomyopathy experienced equivalent occurrences of treated and potentially lethal arrhythmias irrespective of diagnosis duration. These findings suggest that the 9-month time qualifier used in the CMS guidelines for ICD reimbursement may not reliably discriminate patients at high risk for sudden cardiac death in this selected population.
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| http://dx.doi.org/10.1016/j.hrthm.2006.01.012 | DOI Listing |
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