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New SHTAC publication on the effectiveness of ICDs for arrhythmias and CRT for heart failure

Published: 8 September 2014

A new report on the clinical effectiveness and cost-effectiveness of implantable cardioverter defibrillators (ICDs) for the treatment of arrhythmias and cardiac resynchronisation therapy (CRT) for the treatment of heart failure has been published in Health Technology Assessment.

Management of people at increased risk of sudden cardiac death as a result of ventricular arrhythmias and of people with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony has continued to evolve. Options include an implantable cardioverter defibrillator (ICD), which can restore normal heart rhythm, and cardiac resynchronisation therapy (CRT), which resynchronises the contraction of the heart (CRT-P). Devices which combine the functions of a CRT-P and an ICD are known as CRT-D. Given the considerable overlap in the conditions experienced by the different patient groups, uncertainty remains as to which devices provide the most effective options for their treatment.

The systematic review and economic evaluation found that ICDs reduce all-cause mortality in people at increased risk of sudden cardiac death as a result of previous ventricular arrhythmias or cardiac arrest, remote myocardial infarction, or ischaemic/non-ischaemic heart failure and left ventricular ejection fraction less than 35%. CRT reduces all-cause mortality and improves other outcomes in people with heart failure as a result of left ventricular systolic dysfunction and cardiac dyssynchrony when compared with drug therapy. The devices are cost cost-effective at a willingness to pay threshold of £30,000 per quality adjusted life year (QALY) when compared with drug therapy.

The report was commissioned by the HTA programme on behalf of the National Institute for Health and Care Excellence (NICE) to inform guidance to the NHS. The report is freely available from the NIHR Journals Library.

For more information on SHTAC’s research into vascular diseases please visit our Research page.

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