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Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics
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To the Editor: Dr Hernandez and colleagues1 make the case that implantable cardioverter-defibrillators (ICDs) are underused in certain populations as well as in certain subgroups of patients. In this analysis the authors use the outcomes of randomized trials to extrapolate to the expected use of ICDs in the patient population studied. In doing so they make a key assumption and, I think, some key errors.
First, they assume that the outcomes of those patients enrolled in the trials may be generalized to those who were not enrolled and thus to the population as a whole. Many patients screened for enrollment in randomized trials may fit entry criteria but not be enrolled; such nonparticipants may differ from patients who are enrolled in clinically important ways.
Second is the highly selected nature of patients enrolled in the ICD trials. Those included in the analysis by Hernandez et al were 9 to 10 . . . [Full Text of this Article]
Nicholas J. Stamato, MD
njs@cardioassoc.com
Cardiology Associates
Johnson City, New York
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Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics
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Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics—Reply
Adrian F. Hernandez, Gregg C. Fonarow, and Eric D. Peterson
JAMA. 2008;299(3):286.
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RELATED ARTICLE
Sex and Racial Differences in the Use of Implantable Cardioverter-Defibrillators Among Patients Hospitalized With Heart Failure
Adrian F. Hernandez, Gregg C. Fonarow, Li Liang, Sana M. Al-Khatib, Lesley H. Curtis, Kenneth A. LaBresh, Clyde W. Yancy, Nancy M. Albert, and Eric D. Peterson
JAMA. 2007;298(13):1525-1532.
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