Higgins S L
Regional Cardiac Arrhythmia Center, Scripps Memorial Hospital, La Jolla, California, USA.
Am J Cardiol. 1999 Mar 11;83(5B):79D-82D. doi: 10.1016/s0002-9149(98)01007-8.
Since publication of the Multicenter Automatic Defibrillator Implantation Trial (MADIT) in 1996, indications for implantation of implantable cardioverter defibrillators (ICDs) have expanded. Initial criticisms of the study have been addressed, including the need to await the conclusion of several additional ICD clinical trials. These other trials have generally shown an improved survival with ICD therapy when compared with antiarrhythmic agents. As a result, ICD implantation volumes have increased worldwide. However, ICD usage has regional variation with 120 implants per million population in the United States, 45 per million in Germany, but only 7 and 8 per million in France and the United Kingdom, respectively. Although many factors affect implant decisions, reimbursement issues are particularly important. Other factors may explain the slower growth in Europe when compared with the United States including greater skepticism regarding MADIT, less industry-sponsored marketing, and lack of unified cardiology society support for the MADIT recommendations. Nevertheless, it is anticipated that > 50,000 ICDs have been implanted worldwide in 1998, with a growing percentage in the countries of Europe.
自1996年多中心自动除颤器植入试验（MADIT）发表以来，植入式心脏复律除颤器（ICD）的植入指征有所扩大。该研究最初受到的批评已得到解决，包括需要等待其他几项ICD临床试验得出结论。与抗心律失常药物相比，这些其他试验总体上显示ICD治疗可提高生存率。因此，全球范围内ICD的植入量有所增加。然而，ICD的使用存在地区差异，美国每百万人中有120例植入，德国每百万人中有45例，而法国和英国分别仅为每百万人7例和8例。尽管许多因素影响植入决策，但报销问题尤为重要。与美国相比，欧洲增长较慢的其他因素包括对MADIT的怀疑态度更强、行业赞助的营销较少以及心脏病学协会缺乏对MADIT建议的统一支持。尽管如此，预计1998年全球已植入超过50000台ICD，且在欧洲国家的占比不断增加。
