St. Jude Device Exposes Safety Monitoring Failures, Doctor Says

St. Jude Medical Inc.’s Riata, a cable used in heart defibrillators, is the latest example of a defective medical device that wasn’t spotted quickly enough because U.S. surveillance systems are lacking, according to an article in the New England Journal of Medicine.

The company stopped selling the wires in December 2010, and recalled the products a year later because they could break through Riata’s insulation coating and cause a failure. Still, 79,000 of thr so-called leads are inside U.S. patients, said Robert Hauser, a Minneapolis Heart Institute cardiologist.

St. Jude and U.S. regulators aren’t conducting studies needed to guide treatment for patients with Riata leads, though technology is available to do so, the researcher said. Surveillance systems weren’t in place to detect the defects early, even after the need became clear when Minneapolis-based Medtronic Inc. halted sales of its Sprint Fidelis leads in 2007 because of their potential to fracture, Hauser said.

“Patients in the United States continue to be exposed to underperforming and potentially hazardous medical devices after they have been approved by the Food and Drug Administration, despite multiple recalls and some tragic adverse events,” Hauser wrote, in the article released today by the medical journal. “We are confronted once more with a critical clinical situation in which we have no scientifically valid information to guide us.”

Safety Study

St. Jude, based in St. Paul, Minnesota, started a 500-patient Riata Lead Evaluation Study in December 2011 to get more information on how often the wires break free from the insulated cables; evaluate related electrical abnormalities; and help guide future patient management.

A website was introduced to improve communication with physicians and provide additional information, the company said in a statement.

“St. Jude Medical has the most active post-market surveillance program in the industry for these leads,” said Mark Carlson, chief medical officer of St. Jude, in an emailed statement. “St. Jude Medical has a strong history of product safety and reliability, and we remain dedicated to developing technology and products that save and improve the lives of patients.”

The current surveillance system doesn’t detect defects until thousands of patients have been exposed to a new technology, Hauser wrote. There is little information to ensure the safety of any new products, including the St. Jude Durata lead that replaced Riata, or guide the care of patients who receive potentially harmful devices, he said. As a result, doctors react ineffectively and perhaps dangerously, he said.

Spot Problems Early

Manufacturers should conduct studies after devices used to sustain life are released to spot problems early and gather data needed to guide patient care, Hauser wrote. Already, more than 150,000 Americans rely on life-saving medical devices, he said.

“We’re not doing it right,” Hauser said in a telephone interview. “We do have the technology. We even have the software programs that can monitor these devices in real time. We need a vigorous, robust system that keeps these devices under the microscope every day.”

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