The technological imperative and the battle for the hearts of America.

The left ventricular assist device is an expensive, invasive technological approach to advanced heart failure, a condition affecting 5 million Americans, principally the elderly. Given that technology is the leading cause of escalating health care costs, an understanding of the diffusion process of new technology is essential. This case study of the left ventricular assist device (LVAD), while demonstrating the interaction of science, industry, politics, and economics in health care, suggests there are three critical points in the life cycle of a new technology. In the innovation phase, research support by the National Institutes of Health is critical. In the adoption phase, the crucial lever is the decision by the Medicare program to reimburse for the proposed new technology. Finally, in the dissemination phase, regular reevaluation of technology is essential.