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Low Cost, Discount Implantable Cardiac
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Implantable Cardiac Defibrillator
An implantable defibrillator is a device that monitors your heart rate. It uses batteries to send electric signals to a heart thats beating too slow, similar to a pacemaker.
2010 Implantable Cardiac Defibrillator
Surgery Cash Discount Prices
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Implantable Cardiac Defibrillator
I.C.D. single chamber cash discount price $16,200
Implantable Cardiac Defibrillator I.C.D. double chamber cash
discount price $20,900
Implantable Cardiac Defibrillator I.C.D. combo device cash
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Journal Report
04/16/2002
Implantable defibrillators cost-effective for preventing sudden death
DALLAS, April 16 - In the first study of its kind, an implantable cardioverter defibrillator (ICD), a device used to treat heart rhythm abnormalities, was found to be moderately cost-effective for preventing sudden cardiac death, according to a report in today's rapid access Circulation: Journal of the American Heart Association.
ICDs deliver electrical shocks to the heart to eliminate abnormal rhythms such as ventricular fibrillation or ventricular tachycardia. In the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial, the device was shown to be superior to therapy with antiarrhythmic medications for reducing all causes of death in survivors of ventricular fibrillation (irregular, chaotic heart rhythm that begins in the heart's lower chambers). It was also a better choice for people with ventricular tachycardia (an often serious rapid rhythm originating in the lower chambers) and ejection fractions of 40 percent or less. Ejection fraction is a measure of the heart's pumping ability.
AVID is the first study to prospectively determine the cost-effectiveness of ICDs for secondary prevention in the United States, according to lead author Greg Larsen, M.D, a staff cardiologist at the Portland VA Medical Center and associate professor of medicine at the Oregon Health and Sciences University, Portland, Oregon. The study looked only at treating patients who had had life-threatening arrhythmias and were at risk for another life-threatening event. Researchers compared life gained and costs due to ICD treatment with that of antiarrhythmic drug therapy.
To find out which treatment was more cost-effective, researchers compiled data on charges for initial and repeat hospitalizations, emergency room and day surgery stays, and the costs of antiarrhythmic drugs from 1,008 patients. These included 505 patients with an ICD.
Detailed records of all other medical encounters and expenses, including outpatient services and prescription costs, were collected on a subgroup of 237 patients, who were a balanced representation of the larger trial, geographically and medically.
"We called these the 'shoebox patients,' because we told them we wanted all their bills - just bring them in a shoebox," says Larsen.
The researchers converted the charges to 1997 costs. Three-year survival data from AVID were used to calculate the base cost effectiveness (C/E ratio). Six-year, 20-year and lifetime C/E ratios were also estimated.
The researchers determined that the largest expense for these patients is inpatient care, which makes up between 73 percent of total costs for drug therapy patients and 84 percent for ICD patients. At three years, the cost for the drug treatment group was $71,421. For the defibrillator group it was $85,522. The ICD provided a 0.21-year average survival benefit, putting the cost-effectiveness ratio at $66,677 per year of life saved.
"The defibrillator patients lived longer, but they paid extra to get that extra life. The ratio of the additional amount paid for the additional survival benefit is the cost-effectiveness number," Larsen says.
According to Larsen, the conventional wisdom about cost-effectiveness ratios is that something is a "bargain" below about $50,000 per year of life saved, "so the defibrillator is just on the margin of that bargain. It's on the high side but not out of reason."
The researchers also found that six- and 20-year C/E ratios remained stable between $68,000 and $80,000 per year of life saved.
This is only the beginning when it comes to cost-effectiveness studies on the devices, Larsen says. "The cost effectiveness issue is going to be a very big part of the defibrillator story during the next year or two as more and more people look to ICDs for treatment."
For example, there may be changes in some of the big expenses from the ICD group, such as how often the ICD battery may need to be replaced, he says. At three years, 18 percent of the people in this study had to have new batteries. It's also possible that in-patient costs could go down - this study showed shorter hospital stays over time.
"Clearly the cost of these devices is high but the medical care costs are high as well. As the authors point out, ICDs are moderately cost effective in these patients," says David Faxon, M.D., president of the American Heart Association. "We need to continue to study cost effectiveness issues and determine the best practice policies for patients."
Co-authors are Alfred Hallstrom, Ph.D.; John McAnulty, M.D.; Sergio Pinski, M.D.; Anna Olarte, M.Sc.; Sean Sullivan, Ph.D.; Michael Brodsky, M.D.; Judy Powell, B.S.N.; Christy Marchant, R.N., M.B.A.; Cheryl Jennings; Toshio Aklyama, M.D., Ph.D.; and the AVID investigators. American Heart Association
Implantable Cardioverter Defibrillator (ICD)
An ICD is an electronic device that constantly monitors your heart rate and rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle. This causes the heart to beat in a normal rhythm again.
Implantable
Cardioverter Defibrillator (ICD) Single Chamber
Total Costs $16,200
Implantable
Cardioverter Defibrillator (ICD) Double Chamber
Total Costs $22,900
Implantable
Cardioverter Defibrillator (ICD) Combo Device
Total Costs $16,200
How an ICD works
The ICD is an amazing little computer. It monitors the heart rhythm, identifies abnormal heart rhythms, and determines the appropriate therapy to return your heartbeat to a normal heart rhythm. Your doctor programs the ICD to include one or all of the following functions:
- Anti-tachycardia Pacing (ATP) When the heart beats too fast, a series of small electrical impulses are delivered to the heart muscle to restore a normal heart rate and rhythm.
- Cardioversion A low energy shock is delivered at the same time as your heartbeat to restore a normal heart rhythm.
- Defibrillation When the heart is beating dangerously fast, a high-energy shock is delivered to the heart muscle to restore a normal rhythm.
- Bradycardia pacing When the heart beats too slow, small electrical impulses are sent to stimulate the heart muscle to maintain a suitable heart rate.
Why you need an ICD
ICDs are used for:
- people who have had an episode of sudden cardiac death or ventricular fibrillation
- people who have had a heart attack and are at high risk for sudden cardiac death
- people who have hypertrophic cardiomyopathy and are at high risk
- people with at least one episode of ventricular tachycardia
To prepare for an ICD:
- ask your doctor what medications you are allowed to take. Your doctor may ask you to stop certain medications one to five days before your test (such as aspirin products). If you are diabetic, ask your doctor how you should adjust your diabetic medications.
- do not eat or drink anything after midnight the evening before your test. If you must take medications, drink only with a sip of water.
- when you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry or valuables at home.
What to expect:
- You will lie on a bed and the nurse will start an intravenous line (IV) into your arm or hand. This is so you may receive medications and fluids during the procedure. You will be given an antibiotic to prevent infection and a medication through your IV to relax you and make you drowsy, but it will not put you to sleep.
- The nurse will connect you to several monitors. The monitors allow the doctor and nurse to check your heart rhythm, blood pressure and other measurements during the pacemaker implant.
- Your left or right side of your body, from your neck to your groin will be shaved and cleansed with a special soap. Sterile drapes are used to cover you from your neck to your feet. A strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.
The ICD may be
implanted in two ways:
Endocardial
(transvenous) approach most common
|
On rare occasion, it may be necessary for your doctor to implant your ICD by epicardial approach (outside your heart). this requires open heart surgery. Instead of placing the lead through a vein and guiding it to the heart, it is sewn onto the heart. Your doctor will decide if this approach is necessary for you.
The ICD implant takes about two to five hours to perform.
After the procedure:
- Hospital stay: you will be admitted to the hospital for about one to three days. The nurses will monitor your heart rate and rhythm. The length of your hospital stay depends on the type of ICD procedure you had. The morning after your implant, you will have an EKG, blood tests and a chest x-ray to ensure the leads and/or patches and ICD is in the proper position. You will also go to the electrophysiology lab to have your ICD checked. This will involve testing the ICD and programming it to your needs.
- Wound care:
keep your wound clean and dry. After five days, you may take a shower. Look
at your wound every day to make sure it is healing. Call your doctor if you
notice:
- Redness
- Swelling
- Drainage
- Fever
- Chills
You will have a slight bulge under the skin where the generator is located. It will not be noticeable under clothes. If the ICD implant is in your abdomen, avoid wearing tight fitting clothing or tight belts so your wounds will not be irritated.
- ICD
Identification: You will be given information about:
- the type of ICD and leads you have
- the date of implant
- the doctor who implanted them.
In about three months you will receive a permanent card from the company. It is important that you carry this card at all times in case you need medical attention.
- Activity: you
may move your arm normally. You can do most activities when you return home.
- Avoid lifting objects that weigh more than 20 pounds or pushing or pulling heavy objects.
- If you had heart surgery, it may take longer to get back to some activities.
- Your doctor or nurse will discuss specific activities with you before you leave the hospital.
- Electrical interference: most electrical devices, such as microwave ovens, do not interfere with ICD function. You need to avoid strong electric or magnetic fields such as:
- Some industrial equipment, high output ham radios, high intensity radiowaves (found near large electrical generators, power plants or radiofrequency transmission towers), and arc or resistance welders
Stay at arms length away from less powerful electric or magnetic fields such as:
- Large magnets, stereo speakers, airport security wands, antennas used in ham or CB radios.
- Cellular phones should kept at least 6 inches from your ICD and not on the same side as your ICD.
Do not undergo any tests that require magnetic resonance imaging (MRI). You may have CT ("CAT") scans done if necessary
If you have concerns about your job or activities, ask your doctor.
- ICD therapy: You may or may not be aware of when your ICD detects and corrects your heart rhythm. Often it depends on the type of therapy you receive:
- Pacing you may or may not feel the impulses usually they are not detectable
- Cardioversion shock feels like a thump on the chest; discomfort does not linger
- Defibrillation you may be unconscious (passed out) and not feel the shock. If you are awake, the shock feels like a kick in the chest; felt for only a moment.
If you receive a shock:
- Stay calm. Sit or lie down.
- Ask someone to stay with you.
- If you do not feel well after the shock, call your doctor or an ambulance (Dial 911 in most areas).
- If you feel fine after the shock, you do not need to seek immediate medical attention. Call your doctor within 24 hours.
If someone is touching you when the ICD fires, they may feel a tingling feeling. This is not harmful to them.
- Follow-up: Regular follow-up is important after an ICD implant. Your doctor will tell you how often you will need to have the ICD checked. During ICD checks, the doctor will determine if the ICD had detected or treated any abnormal heart rhythms and will check the ICD battery. These visits are very important. You will also need to see a cardiologist at least once a year.
