The American College of Cardiology, American Heart Association and the Heart Rhythm Society Release Updated Cardiac Device-Based Therapy Guidelines
New guidelines offer revised indications for the use of pacemakers, implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices
| Download Updated Cardiac Device-Based Therapy Guidelines |
May 2008
The American College of Cardiology (ACC), American Heart Association (AHA) and the Heart Rhythm Society (HRS) have jointly released updated cardiac device-based therapy guidelines. The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities are the first guidelines that combine indications for all cardiac implantable electronic devices. They were released on May 15, 2008 during Heart Rhythm 2008, the Heart Rhythm Society’s 29th Annual Scientific Sessions.
The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities updates the previous version published in 2002. This revision covers:
- major studies on bradyarrhythmias and tachyarrhythmias, which may be treated optimally with device therapy
- recent changes in the management of heart failure that involve both drug and device therapy, and
- advances in the technology of devices to treat, delay, and even prevent morbidity and mortality from bradyarrhythmias, tachyarrhythmias, and heart failure.
For more information, read the Heart Rhythm Society press release announcing the release of the updated device-based therapy guidelines.
The May 15 announcement was made in San Francisco, site of Heart Rhythm 2008, by Richard Page, MD, FHRS, Chair of the Scientific Sessions Program Committee. “The goal of this document is to improve patient care,” Dr. Page said. “These are the first combined guidelines that include not only pacemakers and defibrillators but also CRT devices.”
The guidelines update those released in 2002, incorporating recent clinical trials and advances in devices and device-management, as well as new drug therapies. Recommendations in the guidelines are supported with evidence levels A through C, with A denoting those supported by multiple randomized clinical trials.
“They are guidelines for therapy and as such have a major impact in terms of third-party payers, Centers for Medicare and Medicaid Services, and others,” Dr. Page said.
Andrew E. Epstein, MD, FHRS, Chair of the Task Force Writing Committee, noted three major changes to the guidelines:
- The elevation of primary prevention of sudden cardiac arrest in patients with ischemia from a level IIa to a level I
- The clarification of the ejection fraction for implantation at 35 percent, and
- The focus on optimized medical therapy for patients
“These guidelines are unique in that we emphasize not just taking care of rhythm problems or heart failure but global cardiovascular needs of patients,” Dr. Epstein said. The term “optimized medical therapy” used throughout the guidelines refers to treatment beyond devices, such as drug therapies, that may reduce the need for devices.
Dr. Epstein said the guidelines also recommend a thorough risk assessment and quality of life discussion with patients and their families. “There is a clear discussion of who should not get devices, and there’s a new section on end-of-life issues,” he said.
The writing committee included experts in the areas of device therapy, cardiovascular care, internal medicine, cardiovascular surgery, ethics, and socioeconomics. The executive summary of the report was published in the Journal of the American College of Cardiology, Circulation: Journal of the American Heart Association, and HeartRhythm Journal.
