A string of presentations and poster sessions during this week’s Heart Rhythm conference pitted device makers against each other in the battle for battery superiority.
Researchers looked at manufacturer estimates and actual rates of failure, probing devices from Medtronic (NYSE:MDT), Boston Scientific (NYSE:BSX), St. Jude Medical (NYSE:STJ) and Biotronik, finding ultimately that the name on the label is the most telling indicator of an implant’s longevity.
Ultimately, each company managed to land some blows against its rivals in this year’s battery wars. No single company endured as the longest-lasting device maker across all types of cardiac rhythm implants, but Medtronic may have taken some of the toughest punches.
One independent study from the Danish ICD registry, which MassDevice.com reported on earlier this week, found that Medtronic CRT-Ds were the 1st to fail when pitted against rival devices.
Another report presented yesterday by noted cardiologist Dr. Robert Hauser of the Minneapolis Heart Institute similarly found earlier battery depletion times for Medtronic CRT-Ds, but noted that the company’s single-chamber ICDs outlasted rival Boston Scientific’s and St. Jude’s.
In the MHI study, each device maker bested its rivals for a single implant type, with Medtronic’s single-chamber ICDs showing a statistically significant boost, Boston Scientific winning the CRT-D category and St. Jude landing 1st place in dual-chamber ICDs.
Medtronic’s single-chamber ICD lasted an average of 7.8 years (+/-1.7), Boston Scientific’s lasted 6.9 years (+/-1.5) and St. Jude’s lasted 6.6 years (+/-1.9). In dual-chamber ICDs, Medtronic’s lasted an average of 6.1 years (+/-1.3), Boston Scientific’s lasted 6.2 years (+/-1.2) and St. Jude’s lasted 6.7 years (+/-1.6). In CRT-Ds, Medtronic’s lasted an average of 4.3 years (+/-1.2), Boston Scientific’s lasted 5.4 years (+/-1.0) and St. Jude’s lasted 4.9 years (+/-1.1).
Hauser added that battery life in all implanted devices had improved significantly from 2009 to 2014, with single-chamber ICDs up to nearly 90 months on average, compared with about 60 in 2009, dual-chambers up to more than 70 months from around 50 months, and CRT-Ds up to more than 50 months from about 40.
Device longevity has played a small part on hospital purchasing habits, but it’s poised to become more important, according to Hauser, a veteran of the MHI and well-known patient safety advocate.
"In general we have not rewarded battery longevity in quite the same way that we should," he said. "Perhaps going forward, as we exit the fee for service environment and we get more into capitated contracts where we’re responsible to the patient for a long period of time, battery longevity will be weighed more heavily in selecting devices."
Implant battery life is an important consideration for both physicians and their patients, as device replacement procedures may put patients at risk of infection, bleeding and damage to the implanted leads that connect the pulse generator to the heart. However, some patients may opt for devices with shorter lifespans if the implants themselves are smaller and less noticeable under the skin, Ohio cardiologist Dr. Harish Manyam told us.
Manyam examined manufacturers’ estimates of the longevity of their CRT-ICD batteries, comparing their advisories against patient outcomes. The study concluded that St. Jude Medical was most often on target with its longevity estimates, where Medtronic generally under-estimated the longevity of its devices and Boston Scientific over-estimated.
All of the studies had important limitations, including a lack of information on the devices’ activity during its life. Device settings and frequency of therapy delivered may have an impact on longevity, but many of the registries used to capture longevity data rarely capture that information.
Battery-wars have been a staple of the cardiac rhythm implant market for years. Last year’s Heart Rhythm conference also featured battery data from Boston Scientific, claiming its single-chamber ICDs, dual-chamber ICDs and CRT-Ds last an average of 13.2, 11.5 and 9.2 years, respectively. In May 2013 Boston Scientific publicly flogged its rivals over device longevity, calling out Medtronic’s claims that its Viva portfolio of cardiac resynchronization defibrillators, which had just recently won FDA clearance, came with an 11-year battery life.
Boston Scientific has something of a reputation for its CRM battery life, having won European Union and FDA approval to market several of its implants as featuring longevity of up to 10 years. In 2012 group purchasing organization Novation highlighted the company’s efforts to boost battery life as a must for all implantable device makers.