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Reuse of cardiac implantable electronic devices to improve and extend lives: a call to action
  1. Thomas C Crawford,
  2. Kim A Eagle
  1. Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Thomas C Crawford, University of Michigan Health System, 1500 East Center Drive, SPC 5853, Ann Arbor, MI 48109-5853, USA; thomcraw{at}

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A dramatic increase in the heart disease burden has taken place in the last several decades. Cardiovascular disease is no longer the disease of the affluent world alone. According to WHO, at least three-quarters of the world’s deaths from cardiovascular disease occur in low/middle-income countries (LMICs).1 Patients in those countries, especially the poorest of the poor, experience enormous obstacles in access to essential medical care. Furthermore, disability from cardiovascular disease contributes to poverty through loss of income and high out-of-pocket expenditures. The World Bank views health as a developmental issue, having direct and indirect effects on economic growth.2 The Institute of Medicine has issued a call to action for partnership and collaboration among a range of public and private sector entities to address the crisis of rising cardiovascular disease.3 According to the report, inadequate access to advanced cardiovascular technologies is one of the major contributors to cardiovascular disease morbidity and mortality in LMIC. The cost of pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy devices (CRTs), commonly referred to as cardiac implantable electronic devices (CIEDs), presents a grave challenge to strained public and individual finances. In many parts of the world, CIEDs are too expensive relative to the economic output to be available to large segments of society. Medical societies, governments and non-governmental organisations have been toiling on ways to extend costly care to the neglected …

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