Table of Contents
Introduction
Defibrillation is the only way to treat someone in cardiac arrest. Every minute a person in sudden cardiac arrest (SCA) does not receive defibrillation, their odds of survival decrease by seven to ten percent, making timely defibrillation critical for survival and one of the most important measures in saving a life from sudden cardiac arrest. Wearable cardioverter defibrillators (WCDs), often known as wearable defibrillators, are a newer form of medical equipment that helps ensure that patients at high risk of sudden cardiac arrest have an extra layer of protection against a potentially fatal occurrence.
What Are Wearable Defibrillators?
Wearable cardioverter defibrillators (WCDs) are external devices that include a defibrillator. The WCD is worn directly on the body by patients who are at risk of sudden cardiac death (SCD) for short-term risk reduction, and it does not require surgery. A wearable cardioverter defibrillator is a temporary treatment option if an implantable cardioverter defibrillator cannot be installed immediately. The wearable cardioverter defibrillators allow patients to live their normal lives without continuously thinking about their risk of sudden cardiac arrest.
The WCD is a non-invasive medical device. It includes a vest, an electrode belt, and a monitor. The vest with the electrode belt is worn under garments throughout the day. The WCD should only be removed while showering or bathing. The monitor can be worn around the waist or on a shoulder strap. The electrodes and wires, which are located on the inner sides of the vest and electrode belt, are directly against the skin. The monitor constantly measures heart rate and rhythm. If life-threatening cardiac arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF) are recognized, the defibrillator administers one or more therapy shocks to restore normal heart rhythm. The time between a cardiac arrest and defibrillation is directly related to survival.
How Does a WCD Function?
WCDs are intended to be worn at all times, save when bathing or swimming, and can be hidden beneath clothing. When in use, WCDs are placed directly on the patient's skin. The monitor receives heart rate and rhythm data and can detect a potentially life-threatening change automatically. If this happens, an alert will sound, or the vest will vibrate to see if the patient is awake. If the patient is conscious, an SCA has not happened, and a shock is not required. Hence, the alarm can be turned off, and no shock will be administered. If the patient is unconscious and unresponsive, the gel will be released over the electrodes in the vest, and a treatment shock will be administered. The entire process, from the start of the SCA event to the delivery of the first shock, typically takes around a minute. If the initial shock does not restore a regular heartbeat, the WCD will administer another. This process will continue for up to five shocks in total.
What Is the Function of Wearable Defibrillators?
The wearable cardioverter-defibrillator is an external device that automatically detects and defibrillates ventricular tachycardia (VT) or ventricular fibrillation. The authorized devices lack pacing capabilities and so cannot provide therapy for bradycardic events or anti-tachycardia pacing.
The wearable cardioverter-defibrillator consists of dry, non-adhesive monitoring electrodes, defibrillation electrodes integrated into a chest strap or vest assembly, and a defibrillator battery and monitor unit. The assure-wearable cardioverter-defibrillator garment comes in two styles for female and male body types and a variety of sizes. The monitoring electrodes are circumferentially placed around the chest, providing two to four surface electrocardiogram (ECG) leads. The defibrillation electrodes are mounted in a vest assembly for apex-posterior defibrillation.
What Exactly Is Insurance Coverage for Wearable Defibrillators?
Most health plans in the United States, including commercial, state, and federal policies, cover the WCD as durable medical equipment (DME) for patients at high risk of cardiac arrest, which includes:
-
Primary prevention for those with an ejection fraction (EF) of 35 percent and a history of myocardial infarction, non-ischemic cardiomyopathy (NICM), or dilated cardiomyopathy This includes coverage throughout the 40-day ICD waiting period following a recent MI.
-
Before and soon following coronary artery bypass graft (coverage throughout the 90-day ICD waiting period).
-
It was listed for cardiac transplantation.
-
One recently diagnosed NICM (coverage throughout the three-to-nine-month ICD waiting period).
-
Heart failure is classified as class IV by the Heart Association.
-
Terminal disease has a life expectancy of fewer than one year.
-
International Classification of Diseases indications when patient condition slows or prevents ICD installation.
What Are the Benefits of Wearable Defibrillators?
The most significant advantage of a WCD is that it constantly monitors the cardiac rhythm and may provide a correction shock almost quickly, without the need for bystander assistance. People frequently experience no signs or symptoms of a rhythm issue. Without a WCD, the patient may not realize they are having an arrhythmia until it is too late. Without any physical symptoms, a patient's health could deteriorate, and they could go unconscious before calling for aid.
Patients may be administered a WCD for a variety of reasons, including:
-
Individuals experiencing diminished heart function after a heart attack or recovering from cardiac damage may benefit from receiving a cardiac stent.
-
People who cannot have an implanted cardiac defibrillator (ICD) surgically inserted or are waiting to have one fitted.
-
Individuals with a history of cardiomyopathy or heart failure.
-
People at high risk of near-term cardiac mortality.
-
Children with ventricular heart rhythm abnormalities are at risk for sudden cardiac death.
-
People now consider additional long-term choices with their care team and need a safeguard.
What Are the Drawbacks of Wearable Defibrillators?
The Heart Association issued a science advisory on WCDs, stating that providers must consider numerous considerations while weighing the risks and advantages of ICD installation and WCDs in their patients. Furthermore, discussing patient preferences is essential to patient care and WCD treatment. More research, particularly randomized trials, is required to understand the best use of WCD therapy better. Some of the crucial aspects to consider include:
-
A High Price Tag: WCDs can be pricey even with insurance coverage.
-
Possible Mishaps: WCDs, like any other medical device, have the potential to malfunction, posing a risk to life.
-
Discomfort: Some patients have claimed they felt bulky and difficult to wear. Skin rashes, itching, and sleep disruption are all possible irritations. Furthermore, some patients have reported trouble getting a WCD to fit properly.
-
Causing Tension: If and when the various gadget alarms sound, immediate attention is required, which can be burdensome or cause worry.
Conclusion
For some patients, an International Classification of Diseases is the best long-term solution for a high risk of SCD. However, only some are eligible for an ICD. Patients with additional medical problems, heart diseases, inadequate insurance, or infection may be ineligible for an ICD. WCDs can be a non-invasive treatment option in the short or long term. Researchers have been exploring WCDs recently, and some trials are underway.
