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    Defibrillators Lower Heart Failure Death Rate

    Medicare Poised to Expand Coverage of Implantable Defibrillators to 500,000 People

    Know Your Ejection Fraction

    All the patients in the trial had poorly functioning hearts, accessed by a simple test known as ejection fraction. Ejection fraction measures the heart's blood pumping efficiency.

    A healthy heart pumps out 55% or more blood with each beat, but an ejection fraction below this number indicates that the heart is weakening. The patients in the study had ejection fractions of 35% or less.

    McClellan notes that most heart patients with ejection fractions of 35% or less who are Medicare beneficiaries should soon qualify for ICDs. The devices cost about $30,000 per patient.

    "If you have been told you have heart disease, you need to know your ejection fraction and talk to your doctor about it," Alan Kadish, MD, tells WebMD. Kadish and colleagues at Chicago's Northwestern Cardiovascular Institute conducted a similar trial of patients with heart failure treated with ICDs. He also reported a significant survival advantage among patients who got the devices.

    "This test should be routine for heart patients, and, unfortunately, it is not," says Kadish. "Every patient who has had a heart attack and every patient with heart failure should have it."

    American Heart Association spokesman Dan Roden, MD, tells WebMD he expects the clinical impact of the new findings will be "huge."

    "I think people have been waiting for confirmatory data showing the benefits of ICDs, and that is what this study provides," he says. But he adds that many patients who will now be candidates for the device probably don't need it and more study is needed to better define who will and will not benefit.

    Studies have suggested that only about one in five patients who get ICDs end up having an arrhythmia that requires the device to send an electrical charge to the heart. Medicare is proposing a nationwide registry of its ICD recipients to help find out which patients will benefit most from them.

    "Many people who end up getting these devices may not need them, but we have no way of knowing who they are right now," says Roden, who is a professor of medicine at Vanderbilt University Medical Center in Nashville, Tenn.

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