Check casual use of defibrillators, say docs

NEW DELHI: Soccer player Christiano Junior''s fatal collapse on the field may have tragically brought sudden cardiac death into sharp public focus, but cardiologists here are doing so for a different reason: To check the arbitrary use of implantable defibrillators.
These devices, commonly known as ICDs, were believed to prevent sudden deaths in patients of serious heart rhythm disturbances.However, larger trials have shown that these devices are life-saving only in specific conditions and that their excessive use should be avoided.
Senior cardiologists are, therefore, calling for a controlled use of the device which may cost as much as Rs 9 lakh. The cardiologists say that these devices are life-saving for certain conditions, but strict guidelines should check their excessive use in unproven indications.
The device is most commonly required for patients who suffer from faster heart rhythms that can lead to sudden deaths.
The condition is more common in those patients who have had a heart attack. While no figures are available on this condition in India, over 300,000 sudden cardiac deaths occur in the US every year.
"The problem here is that there are no guidelines. Cardiologists suggest implantable devices or certain combination devices. But not in all cases do we see documentation that justifies their use," says a former consultant at KEM hospital in Mumbai, Yash Lokhandwala. The patient, who has been given the device should have had an episode of irregular rhythm of the heart, he said.
Moreover, is the arbitrary use of such an expensive device justified at a public health hospital or for people who can barely afford it? Unless it is life-saving, the indiscriminate and irrational use of the device would result only in unnecessary wastage, point out the experts.
"We need to question that, especially when scarce public health resources are being used. There are times when we can''t save children who need a simple surgery of valve replacement," says Srinath Reddy, professor and head of cardiology at the All India Institute of Medical Sciences.
"Over a year, I would have to put the device in 18 patients to save one," says Lokhandwala explaining the results even in a rational use of the device.