Projected longevities of cardiac implantable defibrillators: a retrospective analysis over the period 2007-17 and the impact of technological factors in determining longevity.

AIMS: Implanters of cardiac implantable electronic devices cannot easily choose devices by longevity as usually current models only have projected longevity data since those with known performance are obsolete. This study examines how projected device longevities are derived, the influencing factors, and their roles in guiding model choice. METHODS AND RESULTS: Ninety-eight implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) models released in Europe in 2007-17 were analysed for reported battery capacities, projected longevities for standardized settings stipulated by the French Haute Autorité de Santé (HAS) and manufacturer-chosen settings. Battery capacities and HAS projected longevities increased during the study period. Based on current drain estimation, therapy functions consumed only a small portion (2-7%) of the battery energy for single- and dual-chamber ICDs, but up to 50% (from biventricular pacing) for CRT-Ds. Large differences exist between manufacturers and models both in terms of battery capacity and energy consumption. CONCLUSION: Battery capacity is not the sole driver of longevity for electronic implantable cardiac devices and, particularly for ICDs, the core function consume a large part of the battery energy even in the absence of therapy. Providing standardized current drain consumption in addition to battery capacity may provide more meaningful longevity information among implantable electronic cardiac devices.

Does 'Manna from Heaven' help? The role of cash transfers in disaster recovery-lessons from Fiji after Tropical Cyclone Winston.

This paper contributes to the evidence on the effectiveness of shock-responsive social protection systems in helping affected households recover from the negative consequences of disasters. It evaluates the influence of the top-up cash transfers provided by the Government of Fiji to poor households in the wake of Tropical Cyclone Winston, which struck the Pacific Island country on 20 February 2016. The impact evaluation strategy incorporates a sharp regression discontinuity design to define treatment and control groups, based on the eligibility threshold of the poverty benefit scheme. The results indicate that treatment households-that is, those that received cash transfers-are significantly more likely to report quicker recovery from various shocks. Female-headed households are more likely to recover from the ramifications, whereas households with older heads are less likely to do so. The presence of a functioning market appears to be a major factor aiding the speed of recovery. Finally, the evidence points towards strong district effects on recovery.