Should we afford implantable cardioverter defibrillator therapy?
A John Camm
This article has no abstract so we have provided the first paragraph of the full text.
Implantable cardioverter defibrillators (ICDs) quickly earned the image of incontestable life preservation. This view prevented appropriate efficacy trials because the sacrifice for patients not randomized to ICD therapy was deemed too great. A need for clinical trials to properly assess the cost and efficacy of device therapy was, however, argued. The cost of ICDs was notable and some serious adverse events were associated with their use. Trials were not, though, favored by the device companies because of sparse experience with ICDs and the learning curves of the investigators possibly being disadvantageous. It took almost a decade to persuade the industry, health-care payers and doctors that it was right and timely to pursue clinical trials.
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