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(Circulation. 2006;113:763.)
© 2006 American Heart Association, Inc.
Issue Highlights
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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ARE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR SHOCKS A SURROGATE FOR SUDDEN CARDIAC DEATH IN PATIENTS WITH NONISCHEMIC CARDIOMYOPATHY?, by Ellenbogen et al. |
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Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death by promptly terminating ventricular tachyarrhythmias and providing a record of the event. Patients and physicians commonly equate arrhythmia termination to an aborted sudden death. Analysis of outcomes and detected arrhythmias in the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial illustrates that this assumption overestimates the ICD benefit. In patients with nonischemic cardiomyopathy, the frequency of sudden death in patients randomized to no ICD was substantially less than the number of arrhythmias detected and automatically treated in the ICD group. These findings indicate that with present ICD programming for prompt arrhythmia termination, ICDs often treat arrhythmias that would not be fatal, although some would likely produce syncope before terminating spontaneously. The survival benefit of an ICD cannot be inferred from detected arrhythmias, suggesting that mortality, rather than ICD therapies, should remain the most important end point for ICD trials. See p 776.
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ASSOCIATION OF A CONTINUOUS QUALITY IMPROVEMENT INITIATIVE WITH PRACTICE AND OUTCOME VARIATIONS OF CONTEMPORARY PERCUTANEOUS CORONARY INTERVENTIONS, by Moscucci et al. |
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Increasing attention is directed toward the importance of improving the quality of health care. A principal challenge is to develop and evaluate interventions to improve systems of care. Investigators in Michigan implemented a continuous quality improvement project, which included feedback on outcomes, working group meetings, site visits, selection of quality indicators, and the use of bedside tools for quality improvement and risk assessment in a consortium of 5 hospitals. They compared the experience of the intervention group with control hospitals that did not participate. Their outcomes were the use of preprocedural aspirin or clopidogrel, use of glycoprotein IIb/IIIa receptor
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