Least protection offered to those most at risk of sudden cardiac death

02/02/05

Inequity of use of implantable cardioverter defibrillators in England: retrospective analysis BMJ Online First

Those most at risk of dying from sudden cardiac death in England are offered the least protection from available preventative measures, say researchers on bmj.com this week.

Implantable cardioverter defibrillators (ICDs), a type of pacemaker inserted into the heart, can prevent sudden cardiac deaths. Yet in those regions with the highest death rates from heart disease, rates of ICD use are conversely the lowest.

100,000 people die each year from sudden cardiac death in the UK. Most of these deaths occur when the heart's rhythm suddenly goes out of sync, causing the heart to stop. But an 'inverse care law' is effectively in operation in England, say the report's authors, with areas with those most at risk given the least amount of effective treatment.

The West Midlands, North West and South West were worst off, with the highest proportion of heart disease sufferers but the lowest ICD implantation rates across England.

The study looked at ICD use over five years from 1998 to 2002. Though implantation rose approximately 250% over that time, England still lags behind other European countries and the US.

Researchers also surveyed three quarters of ICD implantation centres in England to find out why eligible patients are being denied the treatment. They found three main explanations - overall funding issues, a lack of staff to perform the procedures, and that eligible patients are not being identified or referred.

All of the centres also expected to see increasing demands for ICDs in the future. Better planning and greater resourcing of ICD centres are needed to address the inequality in healthcare highlighted in this study, the authors conclude.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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