The Heart Rhythm Society announced the release of three new clinical guidelines during Heart Rhythm 2008. These authored and/or endorsed clinical guidelines and documents provide expert guidance on issues critical to cardiac arrhythmia professionals:
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
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| Andrew E. Epstein, MD, FHRS, Chair of the Task Force Writing Committee. |
On May 15 the Society released new, comprehensive guidelines for device-based therapy, created with the American College of Cardiology and the American Heart Association.The announcement was made 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 will be published in the Journal of the American College of Cardiology, Circulation: Journal of the American Heart Association, and HeartRhythm Journal. Learn more »
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Expert Consensus Statement on the Monitoring of Cardiovascular Implantable Electronic Devices
| The Society's authored and/or endorsed clinical guidelines and documents provide expert guidance on issues such as improving patient care, staying up-to-date on the latest in clinical practice and research and advocating for fair reimbursement. View our Clinical Guidelines index. |
The number of follow-up visits for patients with a cardiovascular implantable electronic device (CIED) exceeds 5.8 million visits each year, and that number will continue to increase as more CIEDs are implanted. To ensure that these life-saving devices are managed properly and patients receive the best possible care, the Heart Rhythm Society and the European Heart Rhythm Association have prepared HRS/EHRA Expert Consensus on the Monitoring of Cardiovascular Implantable Electronic Devices (CIED): Description of Techniques, Indications, Personnel, Frequency and Ethical Considerations. The consensus statement was released on May 14, 2008 at Heart Rhythm 2008.
The topic covered includes the monitoring of CIEDs with a description of the technology, indications for use, personnel involved in monitoring and the frequency and types of monitoring events. Also covered are issues in regard to:
- Data management
- Regulatory environments
- Reimbursement and ethical considerations in respect to device inactivation.
This document has been endorsed by the Society, the European Heart Rhythm Association (a registered branch of the ESC), the American College of Cardiology, and the American Heart Association. Learn more »
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New Pediatric and Congenital Heart Patients Clinical Competency Statement Released
As devices such as pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices become more advanced, these life-saving therapies are being used more frequently in pediatric and congenital heart patients. To ensure physicians are prepared to provide these patients optimal care, the Heart Rhythm Society and the Pediatric Congenital Electrophysiology Society (PACES) have released the first training guidelines for physician knowledge and experience for treating this unique patient population. The statement was released May 14, 2008 at the Society’s 29th Annual Scientific Sessions.
The Heart Rhythm Society and PACES developed a task force comprised of adult and pediatric cardiologists as well as adult and pediatric surgeons to prepare the Heart Rhythm Society/PACES Clinical Competency Statement: Training pathways for implantation of cardioverter-defibrillators and cardiac resynchronization therapy devices in pediatric and congenital heart patients. The task force assessed implant volumes and physician background in 49 pediatric programs that implant pacemakers, ICDs and CRT devices, and these findings serve as a framework for the new recommendations, which have been endorsed by the Society, the Pediatric and Congenital Electrophysiology Society and the American College of Cardiology. Learn more ».
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