On June 30, Vice President Dick Cheney received an implantable cardioverter defibrillator (ICD) at George Washington University Hospital in Washington, D.C. (An ICD is a pacemaker-like device that is inserted into the chest to monitor the heart rhythm. If ventricular tachycardia or ventricular fibrillation should occur - rapid heart rhythm disturbances that often cause sudden death - the ICD can automatically deliver a shock to the heart to restore a normal rhythm, and prevent sudden death. Click here for links related to ICDs.) The news media once again jumped on the occasion to question whether Mr. Cheney is capable of performing the duties of Vice President. As is often the case when it covers unfamiliar medical issues, the media is fixated on the wrong question. Instead of focusing on whether the insertion of an ICD means that Mr. Cheney is getting sicker, a more appropriate question might be: if the electrophysiologic testing and ICD insertion is routine prophylactic care in people like Mr. Cheney, why is it that what happened in Mr. Cheney's case seems so strange and unusual, if it truly represents routine care? The answer: the care Mr. Cheney received on June 30 should be routine, but it's not. And as a result, thousands of people are needlessly dying suddenly each year.
Why people who survive heart attacks die suddenly
Sudden death is responsible for as many as 300,000 deaths each year in the United States alone. In the large majority of these deaths, the cause is ventricular tachycardia or ventricular fibrillation. And most people who die from these arrhythmias have had prior heart attacks. After any heart attack, one of the main tasks of the cardiologist should be to assess the risk of sudden death, and if it is high, to take steps to lower that risk. The first step is to measure an ejection fraction. If it is 40% or less, then the patient indeed might be at high risk, and the next step in the evaluation process should be taken.The next step is to perform electrophysiologic (EP) testing. The EP test is a form of heart catheterization in which the electrical system of the heart (and not the heart's anatomy, as with a standard catheterization) is assessed. If this study confirms that electrical instability is present, then an ICD should be inserted.
For patients evaluated in this way - the routine evaluation performed on Mr. Cheney - the ICD significantly reduces the risk of sudden death. In fact, the ICD reduces that risk to nearly zero.
Why does what happened to Mr. Cheney seem so unusual?
It's because - despite the hundreds of thousands of people with the same condition as Mr. Cheney who die suddenly each year, and despite the clearly-defined steps that ought to be taken to prevent such sudden deaths - very few doctors are actually pursuing these steps. Indeed, so few that the press, the public, and, one suspects, many doctors, are shaking their heads in puzzlement at what might have possessed Mr. Cheney's doctors to behave in such a way. Why, they all seem to be thinking, he must really be bad off!The fact is, doctors are dropping the ball here - big time, as Mr. Cheney might say. Why? Many reasons. Some of it is ignorance of the facts. Some is succumbing to the incredible pressures being exerted on doctors by managed care and by the feds (Medicare and Medicaid) not to spend money. Some is due to the fact that - unlike Alzheimers or arthritis - sudden death does not have a constituency. But whatever the reason, the vast majority of heart attack survivors who, like Mr. Cheney, ought to be receiving ICDs, are not even being screened.
What does all this mean to you?
This means: don't necessarily rely on your doctors to tell you everything that ought to be done after a heart attack. Find out for yourself, and make sure that everything that ought to be done is being done. One of the things that ought to be done is to screen you for a high risk of sudden death.Here is an article describing everything your doctors should do for you after you survive a heart attack.
And here is more recent informationon preventing sudden death after heart attacks.
