ICES Report: Do Ontario Patients with Heart Failure Have Equal Access to Life-Saving Technology?

Abstract

Sudden cardiac death (SCD) is a major cause of mortality, and many such events are due to lethal heart rhythm disturbances or ventricular arrhythmias. Patients with a prior heart attack and left ventricular dysfunction are at particularly high risk of SCD. Although the majority of drug therapies have been ineffective in preventing sudden cardiac death, the implantable cardioverter defibrillator (ICD) – a device similar in size to a pacemaker that allows for heart monitoring and immediate cardiac shock if necessary – has been found to significantly reduce the chance of mortality and arrhythmic death in those at increased risk of cardiac events. Randomized trials of the ICD found that it substantially improved outcome in cardiac arrest survivors. The ICD was also found to offer significant survival benefits when used for primary prevention (i.e., in heart failure patients with no history of a cardiac arrest). The recommendations for ICDs were, therefore broadened to include those who have never had a cardiac arrest, but had reduced cardiac pump function and prior heart attack or heart failure. However, there may be disparities in access to this technology because of its novelty and high cost (approximately $30,000 per device). To better explore possible inequities in the use of implantable defibrillators in a universal healthcare environment, scientists at the Institute for Clinical Evaluative Sciences (ICES) examined the use of such procedures for the primary prevention of sudden cardiac death in Ontario from 1993 to 2004. The Study Using the Canadian Institute for Health Information Discharge