Effects of ICD implantation on quality-adjusted life years in patients with congestive heart failure

Background: Effects of prophylactic implantable cardioverter-defibrillator (ICD) on quality-adjusted life years (QALYs) in patients with congestive heart failure are uncertain. Methods: We developed a decision model for patients at risk of sudden death due to reduced ejection fraction and who had no history of life-threatening ventricular arrhythmias. It estimated the QALYs for ICD strategy as a primary prevention for sudden cardiac death and conventional strategy without antiarrhythmic therapies. Results: In a 3-year time period, the QALYs for patients with conventional strategy were higher than that of ICD strategy (2.19 years vs. 2.14 years). When the mortality rate of conventional strategy exceeded 8.6%/year and the hazard ratio of death for the ICD strategy was lower than 0.70, the ICD strategy was the superior treatment option. Conclusions: The QALYs of patients with ICD could be lower than that of conventional strategy. Incorporating quality of life could affect decision making of ICD implantation. (c) 2007 Elsevier Ireland Ltd. All rights reserved.