Implantation of ICD Grossly Underutilized in Medicare Patients Post-MI

Implantable cardioverter-defibrillators (ICDs) reduce mortality in patients with prior myocardial infarction (MI; but not within 42 days) and left ventricular ejection fraction (LVEF) ≤35%. Current American College of Cardiology/American Heart Association guidelines give a Class I recommendation (i.e., is recommended/should be performed) for patients with coronary artery disease (CAD) and LVEF ≤35% with Class II or III heart failure or CAD with LVEF ≤30% with Class I heart failure.

In a Medicare registry of 10,318 patients with prior MI and EF of ≤35% (median age, 78), the 1-year ICD implantation rate was 8.1% (95% confidence interval, 7.6%–8.7%). Prior coronary artery bypass graft surgery, higher troponin levels, cardiogenic shock, and card…