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The Clinical Use of Implantable Cardioverter Defibrillators: Where Are We Now? Where Should We Go?

Alfred E. Buxton, MD
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From Brown Medical School, Providence, Rhode Island.

Requests for Single Reprints: Alfred E. Buxton, MD, Brown Medical School, 2 Dudley Street, Suite 360, Providence, RI 02905.

Ann Intern Med. 2003;138(6):512-514. doi:10.7326/0003-4819-138-6-200303180-00018
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Cardiovascular disease mortality continues to decline, but patients with left ventricular dysfunction, especially if it results from coronary artery disease, remain at high risk for both sudden and nonsudden death (14). In 1998, the latest year for which U.S. statistics are available, sudden cardiac death occurred in 456 076 persons, accounting for more than 60% of cardiac deaths (5). Overall, age-adjusted sudden death decreased 8.3% from 1989 to 1998. Sudden death decreased 11.7% in men, but only 5.8% in women; in fact, sudden death in women 35 to 44 years of age increased 21% over the 10-year period. The proportion of cardiac deaths in persons who did not survive to receive medical care has also increased. In 1989, 37.8% of cardiac deaths were sudden and out-of-hospital versus 46.7% in 1998. Thus, there remains a pressing need to apply more effective prophylaxis against sudden cardiac death.

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