tag:blogger.com,1999:blog-18943510.post3328864076176991374..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: How Technology Is Straining the Doctor-Patient RelationshipDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-18943510.post-63944808851249410992010-02-18T15:54:01.103-06:002010-02-18T15:54:01.103-06:00MTWA in risk stratification of CDM patients: can i...MTWA in risk stratification of CDM patients: can it help to better select candidates for ICD implantation? First experience of a single Belgian Center (Belgium Congress of Cardiology 2010)<br /><br />Conclusion: MTWA ia an accurate NON-INVASIVE test to select ICD patients for primary prevention of arrhythmic events and sudden cardiac death. Even in our small cohort, a normal TWA test clearly Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-53722628388878409652010-02-13T21:50:44.596-06:002010-02-13T21:50:44.596-06:00Dr Wes, At some point couldn't Microvolt T-Wav...Dr Wes, At some point couldn't Microvolt T-Wave Alternans Be another tool that would help a patient and/or their family make a very expensive choice?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-6350081024230450752010-02-11T14:56:53.176-06:002010-02-11T14:56:53.176-06:00Wes,
I get your point, but your blog post did tak...Wes,<br /><br />I get your point, but your blog post did take pains to point out issues like the NNT, device recalls, and the integrity of the data in IMPROVE-HF You have also been a consistent opponent of direct to consumer ICD marketing (which you may know, I have had a hand in helping develop). All of this seems to be an attack on the "value" of ICD therapy in general. <br /><br />Jayhttps://www.blogger.com/profile/10897176780069403370noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-35661202564271263832010-02-11T06:55:27.648-06:002010-02-11T06:55:27.648-06:00Jay and Anony 11:41PM-
The point of this post was...Jay and Anony 11:41PM-<br /><br />The point of this post was not that ICD's aren't effective or cost-efficient. The point here is that we are running head-long into the very real consideration of price of that technology. ICD companies are under constant pressure from hospitals to lower prices - I get that. Hospitals still see this technology as a major source of revenue and often DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-39311026851074154292010-02-10T23:41:33.602-06:002010-02-10T23:41:33.602-06:00ICD's are not perfect nor are the physicians w...ICD's are not perfect nor are the physicians who implant or refer for them, or the companies who make them. However that does not explain the utilization disparities shown in this study based on race and gender. If the impact of recalls and physicians not buying into the mortality benefit were the only factor at work you would not expect to see such significant variation based on these Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-47768892016786114362010-02-08T13:04:44.675-06:002010-02-08T13:04:44.675-06:00Anonymous:
Per guidelines, ICDs are contraindicat...Anonymous:<br /><br />Per guidelines, ICDs are contraindicated in patient's with expected life expectancy less than one year. <br /><br />The patient you cite has a cardiologist that seems for all intents and purposes to be a greedy coward.<br /><br />I and any other ethical electrophysiologist would have refused ICD therapy for this and any similar patient. If fact, if your patient alreadyJayhttps://www.blogger.com/profile/10897176780069403370noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-7067499747916871642010-02-08T06:28:48.533-06:002010-02-08T06:28:48.533-06:00I agree -- ugly. P4P runs the risk of making us a...I agree -- ugly. P4P runs the risk of making us all idiots. Is it appropriate that someone dying of cancer have their blood pressure controlled or cholesterol controlled?<br /><br />I helped take care of a patient with metastatic cancer who was found to have an EF of 15%. The patients performance status was incredibly good but at the time of the diagnosis was already on 4th line chemotherapy Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-28180590526002479232010-02-08T06:04:29.000-06:002010-02-08T06:04:29.000-06:00Wes,
Very important topic.
ICD use/misuse is a p...Wes,<br /><br />Very important topic.<br /><br />ICD use/misuse is a pet peeve of mine.<br /><br />Had too many words for the comment section so I made it a topic for my longest post to date. <br /><br />Thanks for getting me started.<br /><br />JMMDrJohnMhttps://www.blogger.com/profile/13912535474668244521noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-68067065324386814512010-02-07T23:02:07.013-06:002010-02-07T23:02:07.013-06:00ICDs sure do get beat up a lot on this blog.
Hon...ICDs sure do get beat up a lot on this blog. <br /><br />Honestly, I have a hard time understanding this.<br /><br />--The technology is sound.<br /><br />--The data showing benefit is high quality and has withstood peer review, as well as the test of time.<br /><br />--The cost effectiveness is comparable to well accepted standards.<br /><br />--There has been no evidence to refute the Jayhttps://www.blogger.com/profile/10897176780069403370noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-66681377335684106902010-02-07T19:02:29.255-06:002010-02-07T19:02:29.255-06:00Wow. This is just ugly. ICDs are one of the shad...Wow. This is just ugly. ICDs are one of the shadiest areas of manufacturer-medical interaction due to the huge sums of money and ever-expanding "indications". How about the guidelines in other countries? I'm guessing they're not quite so ridiculously liberal with "ICD every single person who may have some benefit in survival". But then, in other countries they'Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-1346817423217466002010-02-07T07:38:30.116-06:002010-02-07T07:38:30.116-06:00Great post. The problem with guidelines are that ...Great post. The problem with guidelines are that they are just that - guidelines and need to be applied after appropriate consideration of patient factors. Most guidelines are based on trials done on patients with specific conditions and after excluding patients with other diseases. When the evidence from those trials is used in real life patients with multiple problems the situation calls forNeil Mehtahttps://www.blogger.com/profile/14898382215427962801noreply@blogger.com