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NICE guidance expected to increase ICD use

Date published: 06/12/2005

The National Institute for Clinical Excellence (NICE) has approved the use of implantable-cardioverter defibrillators (ICDs) in patients at risk of heart attacks.

The devices are used to prevent sudden cardiac arrest in individuals who have recently had a heart attack, have a damaged heart or have had recently undergone surgery to treat heart disease.

The UK has fewer patients with ICDs than anywhere else in the developed world, with less than 20,000 having the devices installed. The US has one of the highest number of individuals with ICDs, at 400 per million population.

Spokesman of the physicians group Heart Rhythm UK Dr Derek Connelly said: "NICE's new guidance on ICDs is good news for those at risk of sudden cardiac arrest, which currently kills 90,000 people every year in the UK.

But Dr Connelly added that the guidelines did not go far enough: "Without a clear steer from the NHS, the guidance will likely languish and end up having a negligible impact on clinical practice. That would be more than a shame."

He also lamented NICE's decision to not give guidelines on other categories of patients who could benefit from ICDs. No advice was given for either patients who require secondary heart attack prevention, or suffers of dilated cardiomyopathy who are at risk of sudden death.

"Clinical trials tell us that their risk of sudden death is as high as that of patients with coronary heart disease," said Dr Connelly, "and that ICDs can also save their lives. Patients and families with this condition will be disappointed that NICE have chosen not to recommend treatment".

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