March 19, 2002 (Atlanta) - Millions of heart-attack patients would live longer if they got a costly implanted device. The finding -- reported here at a meeting of heart doctors -- - is considered the biggest breakthrough in heart attack treatment since the discovery of modern heart medicines a decade ago.
The device is a tiny defibrillator, the machine used to shock a sick heart back into its normal rhythm. The computerized device senses when the heart gets out of whack and gives it a well-placed shock that makes it beat normally. It's the type of device used by Vice President Dick Cheney to prevent cardiac arrest.
The device now is used only on patients whose hearts already have life-threatening rhythm problems. Most of the time, these are people whose hearts are damaged as a result of a heart attack. Now it appears that the device could actually prevent the rhythm problems in the first place in these people.
The new study shows that using the device reduces the risk of cardiac arrest or sudden death by one-third in a selected group of heart attack patients.
Without the device, these people have a 95% chance of dying before they can be rushed to a hospital when they experience the abnormal heart rhythm. With the device, a person has a much better chance of surviving -- and living for many more years. The study shows that many more people -- half of all heart-attack survivors -- could benefit from the device than previously thought.
"This will have profound implications," says study leader Arthur J. Moss, MD, of the University of Rochester, N.Y. "
By lowering the risk of death by a third, the device will have an impact on treating heart attack similar to that of powerful new drugs. The good news is that the device adds to the benefit of these drugs.
"The ability to ... have that significant an increase in survival is remarkable," says Marc A. Pfeffer, MD, PhD, of Harvard Medical School.
The device is not for everyone who has a heart attack. It's only for those whose hearts can't pump blood very well after the heart attack. Doctors use a measure called ejection fraction to determine this. That's the amount of blood the heart can pump out at one time.
When the heart's working well, every time it beats it squeezes out at least 55% of the blood in its main chamber. That's an ejection fraction of 55%. The new study shows that heart attack patients with an ejection fraction of 30% or less should get the new device.
"That is 3 million people in the U.S. -- 300,000 new people each year," Moss says. "It tells you about the magnitude of patients who could benefit. Preventive treatment [with this device] is ready for prime time."
A major problem is the cost of the device. Douglas P. Zipes, MD, president of the American College of Cardiology, estimates the total cost to be $60,000 per patient including surgery. That's already keeping people who need the device from getting it.
"Even if you just consider the existing guidelines, two-thirds of Americans are not getting [these devices] who should be," Zipes says. "I've urged device companies to make a scaled-down version that could be sold for $10,000 or so. But the financial implications are profound, given the cost today."