March 17, 2009

Defibs: Small benefit for some seniors

A U.S. study suggests older people with comorbidities or multiple hospital admissions for heart failure receive little benefit from implanted defibrillators.

The cohort study was conducted among more than 14,000 patients with heart failure using an administrative five-year data base. Researchers from Brigham and Women's Hospital and the Harvard Medical School in Boston said the patients, with a mean age of 77 years, had a high level of comorbidities such as other cardiovascular disease, diabetes, chronic pulmonary disease and kidney disease.

Survival declined progressively after repeated hospital admissions and implantable defibrillators would have apparently extended life by slightly more than six months, the scientists said. However, they found patients under 65 years of age and older patients without kidney disease, cancer or dementia would be most likely to benefit from implantable defibrillators to prevent sudden death.

In contrast to our observations, information from the U.S. National Cardiovascular Data Registry for 2006-2007 indicates that implantable defibrillators are frequently implanted in older patients with heart failure: 61 percent of patients were 65 years or older and 15 percent were 80 years or older, said Dr. Soko Setoguchi and colleagues. Fifty-eight percent of patients had previously been admitted to hospital and comorbidities were common.

The study is detailed in the Canadian Medical Association Journal.