Gillian D. Sanders, PhD; Mark A. Hlatky, MD; Nathan R. Every, MD, MPH; Kathryn M. McDonald, MM; Paul A. Heidenreich, MD, MS; Lori S. Parsons, BS; Douglas K. Owens, MD, MS
Acknowledgments: The authors thank the other investigators in the Cardiac Arrhythmia and Risk of Death Patient Outcomes Research Team (CARD PORT) for reviewing the model and data sources. They also thank Lyn Dupré for editorial assistance.
Grant Support: In part by the Cardiac Arrhythmia and Risk of Death Patient Outcomes Research Team grant (HS 08362) to Stanford University from the Agency for Health Care Policy and Research. Drs. Owens, Heidenreich, and Every are supported by Career Development Awards from the Veterans Affairs Health Services Research and Development Service.
Requests for Single Reprints: Gillian D. Sanders, PhD, Center for Primary Care and Outcomes Research, 179 Encina Commons, Stanford University, Stanford, CA 94305-6019; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Sanders and Owens and Ms. McDonald: Center for Primary Care and Outcomes Research, 179 Encina Commons, Stanford University, Stanford, CA 94305-6019.
Drs. Hlatky and Heidenreich: Department of Health Research and Policy, HRP Building, Stanford University, Stanford, CA 94305-5405.
Dr. Every: Frazier & Co., 601 Union Street, Suite 3300, Seattle, WA 98101.
Ms. Parsons: Ovation Research Group, 805 Fir Place, Edmunds, WA 98020.
Author Contributions: Conception and design: G.D. Sanders, M.A. Hlatky, N.R. Every, K.M. McDonald, P.A. Heidenreich, D.K. Owens.
Analysis and interpretation of the data: G.D. Sanders, M.A. Hlatky, N.R. Every, K.M. McDonald, P.A. Heidenreich, L.S. Parsons, D.K. Owens.
Drafting of the article: G.D. Sanders, M.A. Hlatky, K.M. McDonald, D.K. Owens.
Critical revision of the article for important intellectual content: G.D. Sanders, M.A. Hlatky, N.R. Every, K.M. McDonald, P.A. Heidenreich, D.K. Owens.
Final approval of the article: G.D. Sanders, M.A. Hlatky, N.R. Every, K.M. McDonald, P.A. Heidenreich, L.S. Parsons, D.K. Owens.
Provision of study materials or patients: M.A. Hlatky, N.R. Every.
Statistical expertise: G.D. Sanders, M.A. Hlatky, N.R. Every, L.S. Parsons, D.K. Owens.
Obtaining of funding: M.A. Hlatky, N.R. Every, K.M. McDonald, D.K. Owens.
Administrative, technical, or logistic support: K.M. McDonald.
Collection and assembly of data: G.D. Sanders, M.A. Hlatky, K.M. McDonald, L.S. Parsons.
Sanders G., Hlatky M., Every N., McDonald K., Heidenreich P., Parsons L., Owens D.; Potential Cost-Effectiveness of Prophylactic Use of the Implantable Cardioverter Defibrillator or Amiodarone after Myocardial Infarction. Ann Intern Med. 2001;135:870-883. doi: 10.7326/0003-4819-135-10-200111200-00007
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Published: Ann Intern Med. 2001;135(10):870-883.
More than 1 million Americans per year have acute myocardial infarction (1). Those who survive to hospital discharge have a 5% to 10% risk for dying suddenly within the first year (2–7). Prevention of those sudden deaths is an important goal, and several approaches have been used to accomplish it. Secondary prevention with type I antiarrhythmic drugs has been unsuccessful (8). Prophylactic use of amiodarone has significantly reduced death after myocardial infarction in some but not all randomized trials. Quantitative overviews of these studies suggest that amiodarone reduces mortality rates by 10% to 20% (9, 10). Recent studies of the implantable cardioverter defibrillator (ICD) in patients who have no history of sustained arrhythmia have also had mixed results, with positive results in patients with unsustained ventricular tachycardia (11, 12) and negative results in patients with reduced ejection fraction and positive results on signal-averaged electrocardiography (13). The use of prophylactic ICD has nevertheless attracted great interest because of the demonstrated efficacy of the device in patients who have had a documented episode of ventricular fibrillation or sustained ventricular tachycardia (14–16). Although ongoing or planned randomized, controlled trials (17, 18) will clarify the role of ICDs and amiodarone therapy in patients who have had myocardial infarctions, the results of these trials will not be available until late 2001 at the earliest.
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