Background. Indications to the implantable cardioverter-defibrillator (ICD) have been expanded in the last decade, including patients suffering from heart disease with or without functional disorders. Accordingly, the increasing number of patients with ICD is posing relevant legal implications. Currently, the Medical Committee that evaluates the legal criteria for disability is employing guidelines referring only to pacemaker devices and not to ICD. The aim of this study was to propose new indications for patients with ICD to replace the current criteria. Methods. The study included 219 patients (83%male, mean age 63 years) with ICD who were administered an anonymous questionnaire to evaluate the presence of any disability. Most patients were suffering from ischemic or non-ischemic dilated heart disease (41% and 34%, respectively). Single- and dual-chamber ICD (72%) were more frequently implanted compared to biventricular ICD (28%). Results. A higher percentage of disability was found in older patients (69±14 years) with ischemic heart disease (61%) and single- or dual-chamber ICD before ICD implantation. Conversely, a lower percentage of disability was found in younger patients (53±15 years), active workers (44%), without ischemic or non-ischemic dilated heart disease (36%), and with a lower number of biventricular ICD (22%) after ICD implantation. Conclusions. Overall, these data show that disability is currently recognized because of the presence of ICD rather than the underlying heart disease. We propose, therefore, new criteria that include the impact of the underlying heart disease for a better evaluation of disability in patients with ICD.
The implantable cardioverter-defibrillator: Implications for the recognition of civil disability and proposal for medical-legal update [Il defibrillatore automatico impiantabile: Implicazioni per il riconoscimento di invalidità civile e proposta di aggiornamento medico-legale]
FAVALE, Stefano;
2011-01-01
Abstract
Background. Indications to the implantable cardioverter-defibrillator (ICD) have been expanded in the last decade, including patients suffering from heart disease with or without functional disorders. Accordingly, the increasing number of patients with ICD is posing relevant legal implications. Currently, the Medical Committee that evaluates the legal criteria for disability is employing guidelines referring only to pacemaker devices and not to ICD. The aim of this study was to propose new indications for patients with ICD to replace the current criteria. Methods. The study included 219 patients (83%male, mean age 63 years) with ICD who were administered an anonymous questionnaire to evaluate the presence of any disability. Most patients were suffering from ischemic or non-ischemic dilated heart disease (41% and 34%, respectively). Single- and dual-chamber ICD (72%) were more frequently implanted compared to biventricular ICD (28%). Results. A higher percentage of disability was found in older patients (69±14 years) with ischemic heart disease (61%) and single- or dual-chamber ICD before ICD implantation. Conversely, a lower percentage of disability was found in younger patients (53±15 years), active workers (44%), without ischemic or non-ischemic dilated heart disease (36%), and with a lower number of biventricular ICD (22%) after ICD implantation. Conclusions. Overall, these data show that disability is currently recognized because of the presence of ICD rather than the underlying heart disease. We propose, therefore, new criteria that include the impact of the underlying heart disease for a better evaluation of disability in patients with ICD.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
