Implants Protect People With Heart Failure
Advanced Pacemakers, ICDs Reduce Risk of Death for Those With Heart Failure
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ICDs Reduce Sudden Death Risks
In the second study, researchers looked at whether an
implantable defibrillator was useful as a primary prevention tool in people
with a form of heart failure known as nonischemic cardiomyopathy. This type of
heart failure is not caused by coronary artery disease or hardening of the
arteries and commonly causes sudden death due to an irregular heartbeat.
Researchers say treatment with drugs such as ACE inhibitors and
beta-blockers has been shown to prolong the lives of people with this type of
heart failure, but these people are still at risk for sudden death due to
ICDs have been used as a preventive measure to protect against
sudden death in people who have already experienced cardiac arrest or rapid and
irregular heartbeats, but researchers say that this was the first large-scale
study to look at whether defibrillators might also provide benefits in
preventing sudden death in people with this type of heart failure.
In the study, researchers randomly assigned 458 people with
this type of heart failure to receive standard drug therapy or drug therapy
plus an ICD. The participants were then followed for nearly two-and-a-half
During that time, 68 deaths occurred, but only 28 of them
occurred in the ICD group compared with 40 in the standard therapy group.
Seventeen of the deaths were sudden deaths caused by an irregular heartbeat:
three in the ICD group and 14 in the drug therapy group.
Based on those results, researchers say it's too soon to
recommend routine implantation of ICDs in all people with heart failure not
related to coronary artery disease. But the apparent benefit of the devices in
certain subgroups suggests that use of these devices should be considered on a
Valuable Information, but Proceed With Caution
In an editorial that accompanies the study, Joseph G. Rogers,
MD, and Michael E. Cain, MD, of Washington University School of Medicine, say
these studies add critical new information about the use of the new generation
of advanced pacemakers and implantable defibrillators to prevent future
They say that until now, trials evaluating this approach have
been small and evaluated the quality of life, exercise performance, and other
heart performance factors. This new data on their health benefits in reducing
illness and death is needed as doctors begin to use these relatively expensive
therapies in a larger group of patients.