Defibrillators may have little benefit for older people with comorbidities

Mar 16, 2009

Older people with comorbidities and those with multiple hospital admissions related to heart failure are unlikely to receive a meaningful survival benefit from implanted defibrillators, found a study in CMAJ by researchers from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts http://www.cmaj.ca/press/pg611.pdf.

The cohort study looked at more than 14 000 with using an administrative database over 5 years. The mean age of the group was 77 years, and patients had a high level of comorbidities such as other cardiovascular disease, diabetes, chronic pulmonary disease and .

Survival declined progressively after repeated and would have apparently extended life by just over 6 months. However, 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 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," write Dr. Soko Setoguchi and coauthors. Fifty-eight percent of patients had previously been admitted to hospital and comorbidities were common.

The health and social burden of heart failure is significant, with 1.09 million related hospital admissions in the United States in 2003 and 106 130 admissions in Canada in 2001. Implantable defibrillators have shown benefit for people with heart failure in studies, but trials often exclude the elderly and patients with comorbidities.

"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," writes Dr. Paul Dorian from the University of Toronto and St. Michael's Hospital, Toronto, in a related commentary www.cmaj.ca/press/pg599.pdf.

Source: Canadian Medical Association Journal

Explore further: Key element of CPR missing from guidelines

add to favorites email to friend print save as pdf

Related Stories

Proton pump inhibitors increase risk of bone fractures

Aug 12, 2008

Patients who use proton pump inhibitors for 7 or more years to treat reflux, peptic ulcers and other conditions are at greater risk of osteoporosis-related fractures, according to this large observational study of 15,792 ...

Better patient outcomes with drug eluting stents

Dec 18, 2008

Patients receiving drug eluting stents (DES) — stents coated with medication to prevent narrowing of the artery — as part of an angioplasty had better outcomes one year later than patients with bare metal stents, according ...

Recommended for you

Exploring 3-D printing to make organs for transplants

2 hours ago

Printing whole new organs for transplants sounds like something out of a sci-fi movie, but the real-life budding technology could one day make actual kidneys, livers, hearts and other organs for patients ...

High frequency of potential entrapment gaps in hospital beds

3 hours ago

A survey of beds within a large teaching hospital in Ireland has shown than many of them did not comply with dimensional standards put in place to minimise the risk of entrapment. The report, published online in the journal ...

Key element of CPR missing from guidelines

Jul 29, 2014

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Burnout impacts transplant surgeons (w/ Video)

Jul 28, 2014

Despite saving thousands of lives yearly, nearly half of organ transplant surgeons report a low sense of personal accomplishment and 40% feel emotionally exhausted, according to a new national study on transplant surgeon ...

User comments : 0