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Dual-Chamber Pacemakers Better for Heart Patients

They cost more, but reduce hospitalizations and disability, study finds

MONDAY, Jan. 3, 2005 (HealthDayNews) -- Dual-chamber pacemakers may be more expensive than single-chamber models, but they're worth it because they reduce the risk of hospitalization and disability, a new study finds.

"Most people in the United States [who need an artificial pacemaker] receive dual-chamber pacemakers," said study co-author Dr. David J. Cohen, an associate professor of medicine at Harvard Medical School.

But, he added, "The cost effectiveness of dual-chamber pacemakers had not been studied."

The findings appear in the Jan. 4 online issue of Circulation.

For the study, Cohen and his colleagues used four years of data from 2,010 patients enrolled in a clinical trial who needed a pacemaker because of a condition called sick sinus syndrome, in which the sinus node -- the heart's "natural" pacemaker -- becomes defective. Then they projected the trial findings over a patient's lifetime.

People with sick sinus syndrome have very slow heartbeats and are prone to chest pain, dizziness, fainting and fatigue.

An artificial pacemaker is a small, battery-operated device that helps the heart beat in a more regular rhythm.

Cohen's team found the dual-chamber pacemakers reduced the risk of hospitalization and disability, and the added cost was very favorable over a patient's lifetime.

"The dual-chamber pacemaker stimulates both the upper and lower chambers of the heart and more closely approximates the normal heartbeat," Cohen said. Single-chamber models stimulate a single chamber, "which is sufficient to keep blood pumping and keep the person from passing out but in some patients is not tolerated."

Cohen said 1,014 patients had a dual-chamber pacemaker and the other 996 had single-chamber devices. The median age was 74, and 48 percent of the people were women.

Dual-chamber pacemakers cost about $3,000 more than single-chamber devices during the first four years of the study. Over a lifetime, the dual-chamber models had a cost of $59,104; the single-chamber models, $58,160, Cohen said.

Patients with dual-chamber devices were less likely to be hospitalized with heart failure than those who got the single-chamber models. And those with the dual-chamber models had a slightly lower risk of death or stroke, along with much better results on several measures of health-related quality of life.

"Dual-chamber pacemakers, at their current cost, looked like a reasonable value when we looked at it over the lifetime," Cohen said, adding the benefits increased over time after the initial four-year data. "Over the first four years, it looked like a borderline investment," he said.

Cohen and his colleagues found that during the first four years, the dual-chamber pacemakers increased "quality adjusted life expectancy" by 0.013 years per patient at an incremental "cost-effectiveness ratio" of $53,000 per quality adjusted year of life gained.

"In the U.S., treatments that have cost-effectiveness ratios of less than $50,000 are generally considered favorable," he said.

But the dual-chambers' cost effectiveness improved when the researchers projected the results over a lifetime. They estimated the dual-chamber models would increase quality adjusted life expectancy by 0.14 years with an incremental cost-effectiveness ratio of about $6,800 per quality adjusted year of life gained. "That would be a very favorable ratio," Cohen said. It would be comparable, he added, to results from treating severe high blood pressure, or giving statin drugs to lower cholesterol.

Dr. William Weintraub, a professor of medicine at Emory University School of Medicine, called the new research "a very good study and a difficult study to do."

The take-home message for consumers? If you need a pacemaker, get a dual-chamber model. "It is going to make you feel better," Weintraub said.

More information

To learn more about pacemakers, visit the American Heart Association.

SOURCES: David J. Cohen, M.D., associate professor, medicine, Harvard Medical School, Boston; William Weintraub, M.D., professor, medicine, Emory University School of Medicine, Atlanta; Jan. 4, 2005, Circulation online
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