Prof. Josep Brugada
The number of cardiac devices used in Europe and USA is very different. It does not seem that indications are different but implementation of therapy leads to a 3 to 1 ratio in the number of devices implanted. Some controversy also exists on the cost-effectiveness ratio, which should be used as a marker of economically reasonable health care practice. In this session, 4 specialists, 2 from USA and 2 from Europe analyzed why these differences exist.
Dr. F Arribas exposed the European view of moderation in the indications based on the clinical status of the patient, age, and concomitant diseases. Cultural reasons (sudden death perceived as a "not so bad" way of dying by the community, and sudden death perceived as a fatality that will anyway occur and not as an accident that can be prevented), economical reasons (public system that gives priority to the resources for other purposes) and different perception of the physicians on the role of the guidelines (mandatory to follow in the USA but viewed only as a recommendation by the European cardiologists) would be possible explanations of these differences.
Dr. B Lindsay insisted on the role of guidelines based on scientific evidence to support the expanding approach used in the USA. He suggested that the number of patients that should receive a device should be even higher than the actual number in the USA. However, agreement was reached about the need to have data that support the fact that patients receiving a device have the same behaviour as the ones included in the studies used to create the guidelines.
Dr. L Kappenberger and Dr. M Hlatky analyzed from different points of view the cost-effectiveness ratio of different populations receiving a device, and concluded that in the majority of cases, the treatment is cost-effective and there are no economical reasons justifying the differences across the Atlantic. Interestingly, many of the currently accepted treatments (non devices) were never analyzed in this way, and if they were, they would be considered non cost-effective and in spite of that, nobody would dare to stop them.
The huge difference in the number of devices implanted between Europe and USA cannot be explained by different indications, but rather by cultural and economical reasons.
The use of cardiac rhythm devices in Europe and the USA. Why the huge gap?
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