A study in CMAJ establishes that implanted defribrillators do not provide a significant survival benefit for elderly patients with comorbidities or individuals with numerous hospital stays linked to heart failure. The investigation was carried out by researchers from Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts http://www.cmaj.ca/press/pg611.pdf.

More than 14,000 patients with heart failure were included in the cohort study with an administrative database of over five years. The group’s average age was seventy seven years. Patients had an significant level of comorbidities. They had other medical conditions such as other cardiovascular disease, diabetes, chronic pulmonary disease and kidney disease.

After consecutive hospital admissions, the survival rate declined gradually. It appears that implantable defibrillators actually extended life by just over six months. The patients most likely expected to benefit from implantable defibrillators to prevent sudden death, were under sixty five years’ old or older patients with no other complications such as, kidney disease, cancer or dementia.

Dr Soko Setoguchi and team write, “In contrast to our observations, information from the US National Cardiovascular Data Registry for 2006-2007 indicates that implantable defibrillators are frequently implanted in older patients with heart failure: 61% of patients were 65 years or older, and 15% were 80 years or older”. Comorbidities were frequent and 58 percent of patients had been admitted to a hospital earlier.

There were 1.09 million hospital admissions in the United States in 2003 and 106,130 admissions in Canada in 2001, all related to heart failure. This underlines the important health and social burden of heart condition. Studies have established the benefit of implantable defibrillators for patients with heart failure. However, they frequently leave out older people and individuals with comorbidities.

In a related note, Dr Paul Dorian, University of Toronto and St. Michael’s Hospital, Toronto, writes: “As Setoguchi and colleagues 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% or so of potentially treatable sudden deaths were prevented, the overall risk of death would remain prohibitively high.” http://www.cmaj.ca/press/pg599.pdf.

Written by Stephanie Brunner (B.A.)