心脏性猝死与ICD防治..ppt

* By examining the Kaplan-Meier survival curves, we note that the ICD benefit began after approximately one year. Importantly, as demonstrated by the widening of the curves over time, the ICD benefit appears to increase over time. In an important recent analysis, Dr. Moss announced that there was a 40% cumulative probability of appropriate ICD therapy (ATP or shock) for VT or VF during the 4-year follow-up after ICD implantation. This finding clearly shows the improving cost-effectiveness of ICD therapy with longer follow-up periods.[i]  [i] Moss, Arthur. MADIT I and MADIT II. Journal of Cardiovascular Electrophysiology. Vol. 14, No. 9, September 2003 * * * * * * * Based on populations defined by the criteria of the studies listed, at most 8% of the clinically eligible patients actually receive an ICD. Back-up information: Q. How have you estimated the patient population ? The patient population fulfilling study criteria is an estimate. Even if patients contraindicated, (for secondary co-morbidity, advanced age, etc.) were excluded, it is clear that we would still be left with huge number of patients who are not being treated today. It is important to note that, as of 2004, all the above studies – with the exception of COMPANION and SCD-Heft (which have been published very recently) – are already in the official ESC guidelines for ICDs. The Centers for Medicare and Medicaid Service U.S (CMS) has recently proposed to expand coverage for ICDs to include patients with LVEF 0.30, both ischemic and non-ischemic. (CMS press release, 28 September 2004) If interested to compare these numbers with those in the U.S., please see the pertinent slide in the back up slides. Epidemiology for Europe as a whole was estimated using clinical data published over a 13 year period within several geographies; i.e UK, Nordic etc.. The histograms in yellow simply apply the study criteria to the entire population (e.g., for MUSTT, patients surviving 1 month post MI, LVEF 0.40,