Expansion of Heart Failure Device Therapy Into a Rural Indigent Population in Louisiana: Potential Economic and Health Policy Implications

BackgroundResearch regarding the use of implantable devices in patients with congestive heart failure (CHF) has shown mortality benefits. The Center for Medicare and Medicaid Services (CMS) approved new criteria for expanding coverage for such therapies. The purpose of this study was to determine the percentages of CHF patients in a rural, indigent heart failure population that would be eligible for implantable defibrillators (ICD) and cardiac resynchronization therapy (CRT) based on the new CMS criteria.Methods and ResultsThe new CMS guidelines were applied to information compiled in a database for 451 CHF disease management patients, at Leonard J. Chabert Medical Center. Results show that, annually, 32% of the newly identified CHF patient population would be eligible for ICD therapy and 7.3% would be eligible for CRT therapy.ConclusionsProviders of health care to the indigent may lack sufficient resources for the devices and the infrastructure for device implantation and follow-up.