My friend called to tell me what happened. His voice cracked.
Jim thought that it was a normal Sunday morning ride. He was meeting his friends, and they were riding their normal route, on roads called Covered Bridge, Sleepy Hollow and Wolf Pen Branch. It was one of those Sunday mornings in Kentucky that makes cyclists feel as if they are in church. It had rained for days, but this Sunday morning there was an orange sun rising through the haze of the morning dew. Serene. Spiritual. All this.
For fifty-eight years, Jim had lived right. He was winding down a highly successful professional career. He was physically fitâ€”in the normal way, not the obsessive bike racer way. He had plenty of friends and family. There were no significant medical problems. Jim could not be called inflamed.
Out of the blue, he told his mates that he didn’t feel well. And then, he fell off his bike and diedâ€”in seconds, on a serene Sunday morning with his lifelong friends at his side.
Jim died of sudden cardiac death (SCD). Sadly, this is how one in every five people find out they have heart disease. Jim was a physically-fit Tim Russert.
Sudden death is what heart rhythm doctors are trying to treat with implantable defibrillators (ICDs).Â If Jim had had an ICD, he may still be riding those Sunday rides with his buds.
But Jim wouldn’t have met the CMS guidelines for an ICD.
I am not saying he should have had an ICD. His heart was normal–until that Sunday morning. No test exists that can predict when and if a human heart will fatally quiver. That’s the point: most patients who die of SCD don’t meet the government’s narrowly-defined ICD criteria. Heart doctors tasked with preventing sudden death know this fact all too well.
Jim highlights the human side of the problem that I would like the Department of Justice investigators to know about as they embark on their inquiry of ICDs. That is, when doctors are wrong about withholding an ICD the consequences are grave.
Doctors do not want to overuse ICDs. We know they have significant risks, and that they are very expensive.Â Most good doctors strive to practice evidenced-based medicine. I do. Not just because the government mandates it, but because medical practice is best when backed up by science.
There are ICD guidelines: 40 days after a heart attack, not 39; 35% ejection fraction, not 36%; and 30 seconds of a rapid heart beat, not 29.
Randomized clinical trials.
All stuff that Watson understands well.
And then there are real people like Jim.