Medicare limits the number of conditions under which we will pay for treatment by a cardiac pacemaker (Section 65-6, Coverage Issues Manual). Since the initial formulation of this policy, more recent technological advancements may provide cause to alter the current coverage status.
There is evidence to suggest that beta blockers are beneficial in treating patients post myocardial infarction. However, it is alleged that this treatment increases the risk of AV Block, which impedes effective mechanical and physiological function of the heart. Currently, pacemaker insertion for sinus bradycardia, without significant symptoms, is not a covered service. Requestor has asked HCFA to review the current cardiac pacemaker policy to cover the use of cardiac pacemakers to treat asymptomatic bradycardia, post MI, for patients about to initiate long term beta blocker drug therapy.
All submissions must be received by August 23, 2000.
Please send information to Jennifer Doherty at:
1. The ACC recommendation is for symptomatic, iatrogenic bradycardia. What is the rationale for use in asymptomatic patients who may begin beta blocker therapy?
2. What is the evidence that post MI patients with bradycardia benefit from beta blocker therapy?
3. One proposed definition of asymptomatic bradycardia includes post MI patients with one of the following documented conditions:
Is this a reasonable definition?