Evaluate the research finding published by the Agency for Healthcare Research and Quality (AHRQ) shown in Case Study 1. If you were the administrator of a health care facility, what action would you recommend to ensure that your facility provides the best care for your patients? Support your recommendations with specific details from the research findings.
Case Study #1
Good treatments are available for people at risk for Sudden Cardiac Death
Good treatments are available for people at risk for Sudden Cardiac Death Drug treatment for sudden cardiac death has improved over the years. Deaths from sudden cardiac death can be lowered by preventing the specific heart rhythm disturbances (ventricular arrhythmias) associated with it. The type I antiarrhythmic drugs (sodium channel blockers) often used in the past are no longer considered helpful. In fact, in one study, they were associated with a 21 percent increase in death rates among people at risk for sudden cardiac death. However, some type III antiarrhythmic drugs (potassium chan- nel blockers), including amiodarone and sotalol, are effective. In a systematic review of methods of preventing sudden cardiac death, amiodarone was identified as the most effective medication, decreasing mortality by 13 to 19 percent compared to a placebo. Implantable cardiac defibrillators are effective and their use has expanded markedly. Surgically implanting an ICD to monitor and correct the heart rate can offer additional help. In the same review of treatments to prevent sudden cardiac death, researchers found that when ICDs were combined with other therapy (most often amiodarone), the ICDs reduced mortality by an additional 24 percent. ICDs appeared to be most effective for patients who had an episode of sustained ventricular tachycardia or ventricular fibrillation. The evidence is less strong for patients who had an earlier myocardial infarction and a low ejection fraction. In another study, researchers examined Medicare data for 1987–95 and California hospital discharge data for 1991–95 to study trends in the use and outcomes of ICDs. During the study period, ICD use increased more than tenfold. Mortality rates fell from 6.0 percent to 1.9 percent for the first 30 days after device implantation and from 19.3 percent to 11.4 percent for the year fol- lowing implantation. It could not be determined whether these bet- ter outcomes were the result of improved effectiveness of the device or improved patient selection. Over the study period, the need for device revision or replacement and overall costs remained stable. In another study, it was found that ICD patients had higher over- all costs than patients treated only with medication because of the upfront costs of the device, but their follow-up costs were lower. Quality of life for these patients may be improving. ICDs and antiarrhythmic medications to prevent sudden cardiac death are effective in reducing deaths, but their impact on quality of life (QOL) is less clear. In a study that followed 264 patients with new cases of life-threatening ventricular arrhythmias, QOL decreased at first but gradually improved with time. The overall improvements in QOL were greater for patients with ICDs than for patients treated only with amiodarone. These findings, which contrast with previous research, may reflect advances in ICD tech- nology and differences in study populations. Source: AHRQ Publication No. 03-P022.
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