These May Help People With Moderate Heart Failure
Devices could extend life and bolster guidelines for their use, researchers say
"While there are potential complications with implanted defibrillator therapy, the benefits in appropriately selected patients outweigh these risks, and while the therapy is costly, cost-effectiveness analyses suggest this therapy provides reasonable value," he said.
These findings lend further support for current guideline recommendations to implant defibrillators in eligible patients with an ejection fraction of 35 percent or less, Fonarow said.
The report was published in the June 4 issue of the Journal of the American Medical Association. The study was funded by the U.S. National Heart, Lung, and Blood Institute.
Dr. Bryan Henry, an assistant professor of medicine at the University of Rochester Medical Center in Rochester, N.Y., said the "findings of this paper validate our current guidelines, but are also sobering."
"The absolute benefit is much greater in those with ejection fractions of less than 30 percent than for those between 30 and 35 percent, but statistical benefit still exists," he said.
When discussing these benefits with patients, doctors need to have an honest discussion about the magnitude of benefit, Henry said.
Even patients who have severely decreased function have to be told that, on average, 45 percent will die within three years even with an implanted defibrillator, he said.
"We are making a modest impact with our interventions, but outcomes are still sobering, and we need to continue to focus our efforts on prevention," Henry said.
For the study, researchers studied 3,120 patients with ejection fractions of 30 percent to 35 percent, comparing deaths among those who had implanted defibrillators with those who did not.
They repeated their analysis among 4,578 patients with ejection fractions of less than 30 percent.
The researchers found that survival of heart failure patients with ejection fractions of 30 percent to 35 percent improved in those with implanted defibrillators, compared with those without them. The death rate at three years dropped from 55 percent to 51.4 percent when a defibrillator was implanted, they noted.
Implanted defibrillators were associated with even greater increases in survival among heart failure patients with ejection fractions of less than 30 percent. Among these patients, three-year death rates dropped from almost 58 percent to 45 percent with implantable defibrillator use, the researchers found.