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Heart Device May Not Hurt Life Quality
Sept. 3, 2008 -- Getting an implantable cardioverter defibrillator (ICD) doesn't hamper quality of life for patients with stable heart failure, a new study shows.
Heart failure doesn't mean the heart totally fails; it means it doesn't pump blood as well as it should. Patients with heart failure are at higher risk of developing dangerous heart rhythms. ICDs are surgically implanted devices that don't actually cure heart failure, but shock the heart back to a normal rhythm when needed.
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The new study builds on previous research showing lower death rates among heart failure patients who get ICDs. But receiving a defibrillator shock can be unsettling and uncomfortable, and even though patients live longer, their quality of life may be affected.
According to a new study, getting an ICD "does buy some time and that this time is worthwhile to patients," states an editorial published with the study in tomorrow's edition of The New England Journal of Medicine.
New Defibrillator Study
The study included 2,479 adults (average age: 59-60) with stable congestive heart failure.
The patients were divided into three groups. One group got ICDs. The other two groups got standard medical care plus either the drug amiodarone or a placebo.
Previous research had shown better survival rates in the ICD group. The new analysis focuses on quality of life.
"Basically, we wanted to find out if ICD therapy improves longevity but only at the cost of worse quality of life," says Daniel Mark, MD, MPH, a Duke University cardiologist who worked on the study.
The patients rated their quality of life -- including psychological well-being -- at the study's start and again after three months, one year, and 30 months.
Quality-of-life ratings were higher for the ICD group than the other groups at three months and one year. At 30 months, quality of life was comparable for all groups.
The one exception: Patients who had gotten an ICD shock up to two months before a quality-of-life rating tended not to rate their quality of life as highly. But that appeared to be a short-term effect.
The results show that quality of life was "sufficiently good" with ICDs, write the editorialists, who included cardiologist Jeff Healey, MD, of Canada's McMaster University. Healey's team notes that the study lasted less than four years and might not capture the quality-of-life impact of all potential ICD complications.
In the journal, Mark and several colleagues disclose financial ties to Medtronic, the company that made the ICDs used in the study and helped fund the portion of the study that focused on mortality rates; the National Heart, Lung, and Blood Institute funded the quality-of-life study. Healey and his fellow editorialist both note financial ties to Boston Scientific, another ICD maker.
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