WomenHeart Endorses Expanded Medicare Coverage
of Implantable Defibrillators

Baltimore (February 12) - WomenHeart submitted testimony today before the meeting of the Medicare Coverage Advisory Committee to support expanded Medicare coverage for implantable cardioverter defibrillators to include heart failure patients with a prior heart attack and a low ejection fraction (30% or lower). Major points in its testimony were:

• Lack of appropriate healthcare treatment is a particular problem for elderly female Medicare beneficiaries. Moreover, with each year of advancing age, the majority of Medicare beneficiaries are increasingly women.
  
  
• Event though more women than men die each year of heart disease, women receive only 33% of angioplasties, stents and bypass surgeries; 28% of implantable defibrillators; and 36% of open heart surgeries.
  
  
• The Annals of Internal Medicine last week published an article reporting that women do not receive appropriate therapy following heart attacks, such as beta-blockers, cholesterol lowering drugs or even aspirin.
  
  
• Women are less likely than men post heart attack to be appropriately screened for the risk of sudden cardiac death and are less likely to be referred to an electrophysiologist for an EP study.
  
  
• In women with coronary artery disease and decreased left ventricular function, standard screening for the risk of sudden cardiac death may be less effective than in men. Electrophysiological studies may be less predictive in women than in men as suggested by the Multicenter Unsustained Tachycardia Trial (MUSTT). The rate of inducibility of sustained ventricular tachycardia was found in this population to be lower in women (34% of men vs. 21% of women p=0.001).
  
  
• The MADIT II trial results demonstrate that for patients with a prior heart attack and a low ejection fraction (30% or lower), an EP study is in fact not needed to determine the need for ICD therapy. Coverage of the new indication by Medicare would provide access for a group of very sick female Medicare beneficiaries without the need for an EP study.
  
  
• We also note that past trials, including MUSST, have demonstrated that ICD therapy is equally effective for men and women. We note that in the MADIT II trial, as reported in the New England Journal of Medicine, there is a trend towards even greater risk reduction for women
  
  
• It is important that Medicare provide coverage for this new indication in order to help prevent sudden cardiac death in women over the age of 65. As private payers tend to follow Medicare coverage decisions, the Medicare decision also will affect access for women under the age of 65.
  
  
• Over the past decade, significant research has been done on therapies to treat sudden cardiac death and on the value of ICD therapy. More research needs to be done and more women need to be included in these studies. Medicare coverage will help spur additional research that will benefit women.

Back to top