May 2012

Nearly 20 percent of patients with implantable cardioverter-defibrillators (ICDs) receive painful shocks near the end of life, leaving physicians to question how to care for patients in these trying times. When to initiate end-of-life discussions, as well as the legal and ethical ramifications of withdrawing a device in a terminally ill patient, are challenging considerations for physicians and administrators.

Much of todays technologies qualify as sophisticated but few truly reach the status of smart. For instance, as our cover story illustrates, cardiovascular implantable electronic devices (CIEDs) provide a life-sustaining function in patients at risk of arrhythmias. But when a patient is near the end of his or her life, these devices also may deliver painful shocks.

Cardiac surgeries performed in India cost far less than in the U.S., making them an attractive option for patients who are willing to travel. Researchers who track medical tourism warn that these bargains come with potential health and financial risks. Others say U.S. hospitals should view such overseas enterprises as an example of innovative and cost-effective care.

Four experts share their opinions in a roundtable discussion on the clinical, legal and economic considerations of remote monitoring of patients with cardiac implantable electronic devices with wireless capabilities.

The use of catheter ablation to treat atrial fibrillation (AF) has expanded in recent years. But the complicated technique makes patient selection, operator experience and setting all the more critical to achieve a successful procedure and good outcomes.

When we learned about Accreditation for Cardiovascular Excellence (ACE), we considered it in the context of the challenges that all hospitals are facing. We examined how accreditation empowered physicians, staff and administrators to examine operational processes and make changes reflecting best practices. When ACE became available, it made sense to invest in our cardiac catheterization programs.

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