Implantable Defibrillators Less Beneficial in Some Patients

May offer limited benefit after multiple admissions for heart failure

WEDNESDAY, March 18 (HealthDay News) -- Implantable defibrillators in older patients with comorbidities or repeated hospitalizations for heart failure may produce only limited protection from sudden death, according to research published in the March 17 issue of CMAJ, the Canadian Medical Association Journal.

Soko Setoguchi, M.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues analyzed data from 14,374 patients, mean age 77, who were admitted for the first time due to heart failure. The investigators tracked future heart failure admissions and causes of death, including out-of-hospital cardiac deaths, which they presumed to be sudden death.

During follow-up, out-of-hospital cardiac deaths accounted for 13.7 percent of deaths, the researchers report. Hypothetically preventing all out-of-hospital deaths would prolong life by 0.63 years after the first hospital admission, which fell to 0.28 years after three hospital admissions for heart failure. Patients under 65 -- or older ones free of kidney disease, dementia, or cancer -- would be most likely to have a lower risk of sudden death from implantable defibrillators, the authors note.

"The study by Setoguchi and colleagues reminds us that, in some patient populations, the decision to implant a defibrillator for primary prophylaxis should be made very carefully," writes the author of an accompanying editorial. "As in all areas in medicine, appropriate decision-making regarding the use of implantable defibrillators requires thoughtful consideration of both the clinical trial evidence and the clinical context."

Two co-authors disclosed relationships with Medtronic. The editorial author has received fees and grants from Boston Scientific, Medtronic, and St. Jude.

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Eric Metcalf

Eric Metcalf

Published on March 18, 2009

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