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Implantable Defibrillators May Reduce Mortality

However, device failure rates may be underestimated in randomized controlled trials, observational studies

TUESDAY, Aug. 21 (HealthDay News) -- In adult patients with left ventricular systolic dysfunction, implantable cardioverter defibrillators, or ICDs, effectively reduce the risk of death, according to a systematic review published in the Aug. 21 issue of the Annals of Internal Medicine.

Finlay A. McAlister, M.D., of the University of Alberta Hospital in Edmonton, Alberta, Canada, and colleagues performed a meta-analysis of 12 randomized controlled trials involving 8,516 patients that assessed mortality and 76 observational studies involving 96,951 patients that assessed safety or effectiveness.

The researchers found that ICDs reduced all-cause mortality in the randomized controlled trials and observational studies by 20 percent and 46 percent, respectively. They also found that the most common post-implantation complications per 100 patient-years were lead problems (1.5), device malfunctions (1.4) and site infections (0.6). Inappropriate discharges per 100 patient-years ranged from 19.1 in the randomized controlled trials to 4.9 in the observational studies.

"While we report on patient and device-related complication rates in this review, it should be recognized that it is difficult to estimate the true incidence of ICD device failure. The observed failure rates are probably underestimated because of the tendency to attribute patient deaths to the underlying disease process rather than unrecognized device malfunction," the authors write. "Improved risk stratification to identify patients who are most likely to benefit from ICD are needed."

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