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Medicare expands coverage for device that prevents heart attacks

WASHINGTON—Nearly 500,000 Medicare seniors with heart problems became eligible Thursday for surgically implanted devices that prevent heart attacks by providing an electrical jolt to the heart.

The decision, announced by Medicare administrator Mark McClellan, could save thousands of lives, but it also could further stretch Medicare's strained finances.

Until now, only about 330,000 Medicare recipients were eligible for the battery-powered devices, known as implantable cardioverter defibrillators, or ICDs, although far fewer got them. Medicare expects to pay between $28,000 and $36,000 per person for the surgery, the instrument and pre- and post-operative care, said Dr. Sean R. Tunis, Medicare's chief medical officer.

The coverage expansion will increase by an estimated 25,000 the number of patients who'll get the devices in the next year, officials estimate, potentially saving up to 2,500 lives. Medicare expects ICD implants to cost about $2 billion over five years.

"By increasing the use of defibrillators we are striking a blow against the leading cause of death among older Americans," McClellan said.

Sudden death from a heart attack, often touched off by a rapid, irregular heartbeat known as an arrhythmia, accounts for roughly 50 percent of all heart disease deaths. About 450,000 people die in the United States each year from sudden cardiac arrest.

An ICD, which is implanted in the chest, monitors the patient's heart rhythm and delivers an electrical shock when it detects a life-threatening arrhythmia.

The coverage expansion, first reported by The Washington Post, followed the publication last week of a federal study in the New England Journal of Medicine that showed for the first time that defibrillators can save the lives of people at risk of extremely rapid heart beat, a condition known as ventricular fibrillation.

Currently, only an estimated 25 percent of eligible Medicare patients will get the devices because "it takes a while for new technology and clinical treatments to become widely used in practice," McClellan said. "This is a challenge that I hope we can overcome by developing better information on what kinds of factors seem to be getting in the way of patients that can truly benefit" from an ICD.

As a condition of coverage, Medicare will require that data on patients, their care, providers and the devices be entered in a registry at the time of the procedure. This process will monitor and evaluate the effectiveness of the treatments.

McClellan discounted concerns about the cost of the expanded coverage at a time when a new prescription drug benefit will challenge Medicare's finances.

"You can't deliver modern medicine today, efficiently, without prescription drug coverage or preventative benefits," McClellan said. "Members of Congress, just like our beneficiaries, expect Medicare to keep up to date with what the science has to say about the best way to prevent and treat serious illnesses."

Medicare also proposed Thursday to expand its coverage of ultrasound stimulation for beneficiaries with non-healing fractures who agree to enroll in clinical trials to monitor, evaluate and improve treatments. The proposal removes a requirement that surgery must have failed before ultrasound treatments are covered.

Medicare also issued proposed guidelines on physician use of electronic prescribing technology for Medicare beneficiaries under the new drug benefit, which begins in 2006. Electronic prescription technology has been shown to reduce human error in drug dispensing. Experts estimate that e-prescribing can cut 2 million of the 8 million adverse drug reactions that occur in the United States each year. About 130,000 of those adverse events are life-threatening.

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(c) 2005, Knight Ridder/Tribune Information Services.

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