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Defibrillators May Benefit High-Risk Groups

Survival benefits, cost-effectiveness similar in older unhealthier patients and younger patients

THURSDAY, Jan. 8 (HealthDay News) -- In older patients and those with a limited number of major comorbid conditions, the survival benefits and cost-effectiveness of implantable cardioverter-defibrillator (ICD) therapy are similar to those observed in younger, healthier patients, according to a report published online Jan. 6 in Circulation: Cardiovascular Quality and Outcomes.

Paul S. Chan, M.D., of the Mid-America Heart Institute in Kansas City, Mo., and colleagues compared long-term mortality in 965 patients with ischemic and non-ischemic cardiomyopathies and no prior ventricular arrhythmias, including 494 (51 percent) who received ICDs.

After a mean follow-up of 34 months, the researchers found that ICD therapy was associated with a 31 percent lower risk for all-cause mortality, and that the association was consistent for patients younger than 65, aged 65 to 74, and 75 and older; ischemic ejection fraction of over 25 percent or 25 percent or less; and the presence of major comorbid conditions. The investigators also found that cost-effectiveness was similar across age groups and observed only slight increases in patients with multiple comorbid conditions.

"Although decisions about their use will still need to be individualized for a particular patient, our findings suggest that specific high-risk groups should not be routinely excluded from consideration for ICD implantation," the authors conclude.

Several of the study authors disclosed receipt of grants from device manufacturers.

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