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To the Editor: Dr Hernandez and colleagues¹ provide evidence that women and black patients are treated differently and less aggressively than white men with respect to ICD use. However, I found their final conclusions to be concerning. The authors assert that "[p]rograms for awareness and promotion of evidence-based use of medical devices" are needed and that ICD therapy should be considered as a "publicly reported" measure.

Because of their known benefits and manageable adverse effects, angiotensin-converting enzyme inhibitors and β-blockers may be suitable for nearly all patients with systolic heart failure; therefore, their use in this setting makes for appropriate publicly reported measures of quality.² However, ICDs are different. If not deactivated, ICDs cause significant suffering at the end of life.³ Some patients develop anxiety and depression from the fear of being shocked,⁴ and patients with ICDs have more heart failure admissions than patients without ICDs.⁵

The decision to have . . . [Full Text of this Article]

Dan Matlock, MD
daniel.matlock@uchsc.edu
University of Colorado Health Sciences Center
Aurora

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Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics
Nicholas J. Stamato
JAMA. 2008;299(3):285.
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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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