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MADIT CRT Will Increase Use of CRT Defibrillators

September 2, 2009

Analysis of:Cardiac-Resynchronization Therapy for the Prevention of Heart Failure Events | content.nejm.org

MADIT CRT was designed to assess if an ICD with CRT (vs. ICD alone) affected a combined endpoint of death or heart failure events in patients with mild cardiac symptoms. Over a mean of 2.4 years, the endpoint differed between groups due to a 41% reduction in heart failure events. Those who benefitted the most were those with a QRS of at least 150 ms. Mortality was similar with or without CRT; it was low. ICD with CRT decreased risk of heart failure events in this population.

Dibigatran will change how we manage atrial fibrillation

August 31, 2009

Analysis of:Dabigatran versus Warfarin in Patients with Atrial Fibrillation | www.theheart.org

In patients with atrial fibrillation, rates of stroke and embolism are similar comparing dabigatran, 110 mg, to adjusted dose warfarin.  Rates of major hemorrhage were lower with dibigatran. Dibigatran at a 150 mg fixed dose is  associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage compared to warfarin.  Reference:  Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361.

There are reasons US Hospitals are slow to adopt e-records

April 6, 2009

Analysis of:U.S. Hospitals Slow to Adopt E-Records | online.wsj.com

1.  The process is slow in the US since it is expensive, cumbersome and difficult to train physicians. 2.  The EMR is not necessarily considered a step forward by doctors and other health care professionals. 3.  The EMR does not necessarily improve health care. 4.  The EMR represents a revolution is documentation that is not evidence based or developed with the patient or physician in mind. 

Dronedarone will change medical management of atrial fibrillation

March 19, 2009

Analysis of:FDA advisory panel approves dronedarone | www.drugs.com

Dronedarone will likely transform the treatment of atrial fibrillation.  This is the first new drug for atrial fibrillation in a long time that can add substantially to the care of patients.  I suspect it will be a drug that will become one of the most commonly used to treat patients with atrial fibrillation and likely will be a blockbuster drug for this purpose.

Dronedarone will revolutionize treatment of atrial fibrillation patients

February 18, 2009

Analysis of:The ATHENA Trial, New England Journal of Medicine | news.glgroup.com

Dronedarone is the first antiarrhythmic drug that, by whatever mechanism, reduces cardiovascular mortality and improves other important endpoints.  The drug may work in part by controlling rate in atrial fibrillation and by controlling the rhythm. The drug appears safe especially in patients who do not have severe (or acutely decompensated) heart failure and have left ventricular ejection fraction more than 35%.

The Future of Stereotaxis

March 5, 2008

Analysis of:Stereotaxis shares tank on Q4 loss | www.24x7mag.com

The development of the new technology related to Stereotaxis has been slow going.  While there is much hope there is also much hype.  It is not clear that Stereotaxis really adds much to the success of catheter ablation of atrial fibrillaiton.  There has been a vocal minority who think it is but this is based on scant data.

The INTRINSIC RV Study

June 1, 2006

Analysis of:The INTRINSIC RV Study | www.theheart.org

Dual chamber programming in an ICD is not inferior to single chamber programming.  The Inhibition of Unnecessary Right Ventricular Pacing with AV Search Hysteresis in ICDs (INTRINSIC RV), a multi-center, randomized trial enrolled more than 1,500 patients at 108 centers in the United States, Germany, Italy and Australia  was designed to advance understanding of a proprietary feature that minimizes unnecessary right ventricular pacing in patients who received the Boston Scientific Company's market-released dual-chamber implantable cardioverter defibrillators (ICD’s). While the trial was not designed to test for superiority, investigators noted that patients randomized to dual-chamber pacing tended to have a lower risk of combined all-cause mortality and heart failure hospitalizations compared to those randomized to the single chamber pacing arm.

Possible Changes in Reimbursement for ICDs at Subspecialty Hospitals

May 11, 2006

Analysis of:Proposed Changes To Medicare Rules Get Mixed Reviews | www.investors.com

The Centers for Medicare & Medicaid Services has developed a new set of rules in an extensive document released a few weeks ago. The implications of this document are not clear but it appears that there are going to be major changes in reimbursement for implantable cardioverter defibrillators especially at hospitals that specialize in this type of procedure. This includes academic medical centers, urban hospitals and specialty hospitals. These hospitals that may have profited from device implantation may barely break even. There is also evidence that the FDA is now strengthening their evaluation of individual practices of ICD implantation. These proposed changes may have major implications at subspecialty hospitals especially in the Midwest where their concentrations are quite high.

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