Summary

In this article, the American Heart Association (AHA) and Heart Rhythm Society (HRS) discussed the implications of guidelines, some of their limitations, and where guidelines fit in the new paradigm of health care. Specific topics include limitations of the current system of guidelines and how they fit with the new paradigm of health care, the impact of the Medicare and Medicaid services, and the disconnect between indicated ICD therapy as outlined in the ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities [Epstein J et al. J Am Coll Cardiol 2008] and CMS reimbursement rules.