Treatment of Heart Rhythm Disorders
Medical Technology
Saving & Improving Lives
Courtesy of AdvaMed
Advanced medical technology is transforming the treatment of heart rhythm disorders that affect approximately 4 million people in the United States. As a result, we have witnessed dramatic declines in mortality coupled with gains in health system productivity over the last two decades. Implantable cardiac defibrillators clearly illustrate this trend. In 1980, it cost $99,000 to implant a defibrillator, took 2 to 6 hours to complete the operation, and required a hospital stay of 14 to 24 days. Today the technology is substantially improved and provides enhanced patient benefits, yet an implantation costs $44,000, takes a one hour operation and requires only one day in the hospital.
Health Care and Economic Costs: The total estimated direct and indirect economic costs of heart rhythm disorders appear to be in the range of $65-75 billion annually1.
About $30 billion in direct costs, such as hospital, physician, and medication costs.
About $40 billion in indirect costs, including lost productivity due to mortality and morbidity.
The costs associated with congestive heart failure, in which the heart's major chambers do not beat in a synchronized pattern, cost $8-$15 billion each year in the US.
- Heart failure is the main cause of hospital stays in the US.
Heart failure's costs are twice that of cancer2.
Medical Technologies for Treating Cardiac Rhythm Disorders: Previous therapies for heart rhythm disorders often offered only limited treatment or no treatment at all.
- Until pacemakers were introduced, bradycardia patients - those suffering from slow heartbeats - had to sharply curtail their daily activities, often suffered from fainting episodes, and died prematurely3. Early pacemakers were bulky, wore out quickly, paced at one set tempo, and required major surgery.
- Early versions of implantable cardiac defibrillators - to control rapid heartbeats or erratic beats - were large and required major open surgery. Patients stayed in the hospital for two to three weeks and the devices lasted only a few years.
- No cure currently exists for congestive heart failure, other than a heart transplant.
New and Emerging Technologies for Treating Cardiac Rhythm Disorders: A range of new technologies offer cardiac rhythm patients better health, faster return to work, and longer lives.
Pacemakers: Today's pacemakers are smaller, more functional, and last longer than earlier versions. They can be fine-tuned without surgery, and they gather diagnostic information about the patient automatically. Many also adjust the pacing rate to meet the patient's changing needs, such as climbing stairs, exercising, walking, or even gardening.
- System longevity for many pacemakers is more than 10 years, reducing recurrent doctor and hospital care. Average 60 year-old patients will need only two pulse-generators (the pacemaker power source) over the course of a lifetime, not three (as required 15 years ago.)
Defibrillators: Implantable cardiac defibrillators (ICDs) detect and correct erratic heartbeats that can cause sudden death. The devices do so by delivering a slight electrical shock to the heart.
- Today's ICDs are up to 99% effective in stopping life-threatening arrhythmias. They prevent sudden cardiac death and reduce overall mortality 20% - 60%percent when compared to drug therapy. Without an ICD, a person's chances of surviving a cardiac episode of this type are less than 5%.
- Because of their ability to save lives, they have been dubbed "rescue squads" in the chest.
- ICDs cost less than half what they did in 1980. They also provide savings through shorter hospital stays, fewer complications, quicker recovery, and longer patient lives.
- Remarkable improvements have occurred in ICD technology since they were first introduced in 1980:
| ICDs |
1980 |
Today |
| Size/Weight |
200cc, 280 g |
<40cc, <100g |
| Implant method |
Stomach, requiring thoracic surgery |
Pectoral, requiring single incision |
| Hospital stay |
14-24 days |
2 days |
| Operation Duration |
2-6 hours |
1 hour |
| Anesthesia |
General |
Local |
| Battery life |
2-3 years |
9 years |
| Mortality (related to operation) |
9% |
<1% |
| Complications |
Significant |
Virtually none |
| Number |
1,000 |
65,000 worldwide |
| Cost |
$99,000 |
$44,000 |
Vascular Resynchronizers: Vascular resynchronizers employ highly advanced defibrillator technology to correct the mechanical pumping problems that plague many patients with congestive heart failure.
- By bringing all chambers of the heart into proper rhythm, these devices will allow patients to conduct more normal lives-continuing their jobs, doing housework, walking, and climbing stairs. Some models will also be equipped with systems to correct the erratic heart rhythm that can lead to sudden death.
- Congestive heart failure is one of the leading reasons that Medicare patients are hospitalized-more than pneumonia, stroke, kidney ailments, diabetes, and most types of cancer. Many patients spend a month in the hospital over the course of a year.
- Vascular resynchronizers are expected to result in a major savings in the $8-$15 billion that the U.S. spends annually in hospital treatment for congestive heart failure patients.
About Heart Rhythm Disorders: Heart rhythm disorders occur when the heart does not beat properly-too quickly, too slowly, or in a chaotic manner. These disorders are caused by electrical problems within the heart and can result in fatigue, fainting, dizziness, and even sudden death.
Population (US): Heart rhythm disorders affect approximately 4 million people in the US4.
- 750,000 people are affected by slow heart rhythms, called bradycardias.
- 2.2 million are affected by fast heart rhythms, called tachycardias.
- 1.5 million are affected by heart rhythms that occur in a chaotic manner, and which can cause sudden death.
In addition, 5 million are affected by congestive heart failure, in which the main chambers of the heart are unable to beat in a synchronized manner.
- The vast majority of the 220,000 sudden cardiac deaths in the US are believed to be from one type of heart rhythm disorder, called ventricular fibrillation, or erratic beating of the heart's lower chambers5.
- Black males suffer from the highest rate of sudden cardiac death, some three or four times higher than for white females and white males, respectively.
- Approximately 80,000 survivors of heart attacks are at a high risk of sudden cardiac death from heart rhythm disorders. Most have no symptoms6.
1Derived from American Heart Association data; includes costs of cardiac rhythm disorders, rheumatic heart disease, cardiomyopathy, pulmonary heart diseases, some hypertensive disease.
2"Hope is Where the Heart Is," by Catherine Arnst, Business Week, June 26, 2000, p. 170
3"Preserving the Milieu for Medical Innovation," by Glen D. Nelson, M.D., Health Affairs, September 1994, p. 113.
4American Heart Association 2001 Heart and Stroke Statistical Update, 2000, p. 18
5American Heart Association 2001 Heart and Stroke Statistical Update, 2000, pp. 18-19.
6North American Society of Pacing and Electrophysiology (NASPE) News and FAQs, http://www.naspe.org/your_heart/faqs.html
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