Authors' objectives:

This report aims to evaluate the clinical effect and health economics of treatment with implantable defibrillator (ICD) compared to drug treatment. Clinical effect includes effect on survival, complications and quality of life.

Authors' recommendations: ICD as secondary prophylaxis: Three randomized studies show that ICD has a significant beneficial effect on survival of patients who have survived cardiac arrest, ventricular tachycardia or syncope, ventricular tachycardia with seriously affected circulation and concommittant reduced heart function. The annual mortality was reduced from 12.3% to 8.8%. Implantation of ICD in 29 patients would prevent one death per year of follow-up. Observational studies indicate benefit among patients with syncope with concurrent structural heart disease and inducible ventricular tachycardia, with tachycardia seriously affecting the circulation without syncope or cardiac arrest and with good heart function. There is limited knowledge of the effect of such treatment on patients with ventricular tachycardia and few symptoms, but there is probably a beneficial effect on those with reduced heart function. ICD as primary prophylaxis: Two randomized studies show significant beneficial effect on patients with coronary heart disease, reduced cardiac function, non-sustained ventricular tachycardia and inducible ventricular tachycardia. In these studies ICD had to be implanted in 10 and 20 patents, respectively, to prevent one death per year of follow-up. One randomized study showed no effect on total survival among patients with coronary heart disease and planned coronary surgery, ejection fraction less than 36% and positive late potential ECG. With modern implantation techniques the perioperative mortality rate and the risk of later mechanical complications are low. ICD as secondary prophylaxis does not influence quality of life. In a randomized study of ICD as primary prophylaxis there was some evidence of a negative effect of ICD on quality of life, particularly among patients who had received inappropriate shocks. Treatment with ICD is expensive. The units cost about NOK 250,000, and total annual expenses of ICD treatment in Norway can be estimated to approximately NOK 30 million. In high risk patients the cost-effectiveness of this treatment is acceptable. If ICD is used in low-risk patients the cost-effectiveness becomes less favourable. The primary implantation rate in Norway of about 25 per million per year has not changed the last few years. Ongoing research may make it possible to more precisely select the patients likely to benefit most from ICD treatment.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nokc.no/

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;

Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Copyright: The Norwegian Knowledge Centre for the Health Services