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Medicare ICD Coverage

June 10, 2003 - The Centers for Medicare and Medicaid Services
(CMS) has expanded Medicare coverage for ICDs to include "some"
of the patients who meet the ICD-needed standards of the MADIT
II trial. The newly covered patients are those who have a wide
QRS interval.

See www.chfpatients.com/implants/pacemakers.htm#ekg
for QRS interval diagram.

MADIT II's main researcher Dr. Arthur Moss said, "This is about
half the MADIT II study population." The CMS decision expands
coverage to an "enormous number of additional patients" for ICD.
	Dr. Moss added, "We did not find any statistically
significant difference between those who had wide QRS and those
with narrower QRS ... when we looked at every subgroup - young,
old, men, and women - there was very little variation in
findings. So we were surprised by the Medicare decision."
	Medscape CRM Editor Dr. Eric Prystowsky said, "... I do
think reimbursement for patients with QRS duration of more than
120 ms is a step in the right direction. These patients clearly
require an ICD according to MADIT II."
	Medicare said it would approve coverage for patients
with the following conditions:

1) coronary artery disease with prior heart attack, EF less than
   36%, inducible sustained ventricular tachycardia or
   ventricular fibrillation during EPS;
2) prior heart attack, EF less than 31%, and QRS duration over
   120 ms.

Source:  Medscape CRM

Title:   Prophylactic implantation on a defibrillator in patients
         with myocardial infarction and reduced ejection fraction.
Authors: Moss AJ, Zareba W, Hall WJ, et al.
Source:  N Engl J Med. 2002;346:877-883.
Title:   Improved survival with an implanted defibrillator in
         patients with coronary disease at high risk for ventricular
         arrhythmia.
Authors: Moss AJ, Hall WJ, Cannom DS, et al.
Source:  N Engl J Med. 1996;335:1933-1940.
Title:   A randomized study of the prevention of sudden death in
         patients with coronary artery disease.
Authors: Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G.
Source:  N Engl J Med. 1999;341:1882-1890.