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Cardiac Device Implantation Overused in Very Ill Patients

Those who require intravenous inotropic drugs have higher mortality risk, costs

THURSDAY, June 12 (HealthDay News) -- Advanced heart failure patients may be undergoing cardiac device implantation that does not help them and increases their risk of in-hospital mortality because they are too ill to benefit from the treatment, according to research published online June 3 in the American Heart Journal.

Jason Swindle, of the Saint Louis University School of Medicine in St. Louis, and colleagues looked at the in-hospital mortality rate of 27,907 patients with heart failure who underwent implantation or revision of cardioverter defibrillator or cardiac resynchronization devices. The investigators' goal was to identify which patients are poor candidates for the procedures. They also calculated average accumulated costs.

For patients who did not require inotropic drugs -- which are a marker of poor prognosis -- the mortality risk was only 0.3 percent, but for those who required the drugs before, on the day of, or after implantation, the risk was 3.3 percent, 6.6 percent and 15.2 percent, respectively. Costs were also much higher for patients requiring inotropic drugs, the report indicates.

"Implantable cardiac devices were not intended for, or studied as 'rescue therapy' for very ill hospitalized patients with heart failure," study co-author Paul Hauptman, M.D., of Saint Louis University School of Medicine, said in a statement. "Overuse of these devices is a disservice to patients, because it puts them through unnecessary procedures and creates unrealistic expectations for the device."

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