March 18, 2009

Implanted Defibrillator Not For All

A new study may help doctors determine who is a good candidate for an implanted defibrillator -- and who is not.

Data collected from more than 14,000 patients over five years show heart failure patients under age 65, or those over 65 without kidney disease, cancer or dementia could be protected from sudden death with the assistance of an implanted defibrillator. However, older patients with several comorbidities, including other cardiovascular diseases, diabetes, chronic pulmonary disease and kidney disease, and with multiple hospital admissions did not appear to benefit from the devices.

"As [the study authors] point out, patients at extremely high risk of death, including patients with prior (particularly multiple) heart failure hospitalizations and chronic kidney disease, have such a high risk of all-cause non-arrhythmic death that even if the 20-percent or so of potentially treatable sudden deaths were prevented, the overall risk of death would remain prohibitively high," Paul Dorian, M.D., from the University of Toronto and St. Michael's Hospital, Toronto, wrote in commentary of the study.

Study authors note implanted defibrillators have shown benefit to many patients in prior studies, but most of those studies excluded the elderly and patients with comorbidity.

SOURCE: Canadian Medical Association Journal, 2009;180:611-618