Medicare plans to widen coverage of implanted heart devices

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The Centers for Medicare & Medicaid Services plan to widen coverage of implantable cardioverter defibrillators (ICDs) by one-third to prevent risk of heart failure, a predominant health issue for long-term care residents and operators.

CMS expects at least 25,000 more beneficiaries to receive the implants in the first year of the nearly 500,000 Medicare patients eligible, according to the proposal announced on Tuesday. The coverage could potentially save up to 2,500 lives annually, CMS administrator Mark McClellan said.

ICDs lowered the risk of sudden cardiac death by 23% in patients with heart failure during a National Institutes of Health trial that led to the expanded coverage decision. Currently CMS reimburses ICD treatment only for patients whose condition was caused by coronary artery disease.

Heart failure is typically a disease associated with the elderly, according to a special report in Caring for the Ages, an American Medical Directors Association publication. Significant proportions of individuals in long-term care have either suffered from previous episodes or experience their first episode in long-term care, the report says.

Guidant Corp., Medtronic Inc. and St. Jude Medical Inc. are all producers of ICDs. The ICD market should rise 20% to 25% in 2005 and 2006, according to a JP Morgan analysis. The current market for ICDs is about $4.8 billion, according to recent estimates.