Long Term Care

ICDs Increase Older Heart Failure Patients’ Survival

The mortality rate for Medicare patients with heart failure who were treated with standard medications and implantable cardioverter defibrillators (ICDs) was 14.2 percent lower at the three-year follow-up than it was for those treated with medication alone, according to research reported in Circulation: Heart Failure, a Journal of the American Heart Association.

Researchers identified 4,685 patients with heart failure from 65 to 85 years old who were eligible for ICD therapy, had left ventricular ejection fraction (a measure of the heart’s pumping ability) of 35 percent or less, and were treated and discharged from hospitals participating in the OPTIMIZE–HF and the American Heart Association's Get With The Guidelines–Heart Failure quality improvement program from Jan. 1, 2003 through Dec. 31, 2006. They matched the patients to Medicare claims to examine long-term outcomes. The average age of patients in the study was 75.2 and 60 percent were women. The main outcome measure was all-cause mortality (or death) over three years.

The rates of death were significantly lower among heart failure patients who received an ICD compared with those who did not. “In the first year, only 19.8 percent of the patients with an ICD died compared to 27.6 percent without an ICD,” said Gregg C. Fonarow, M.D., study co-author and professor of cardiovascular medicine at the University of California–Los Angeles Medical Center and immediate past chair of the Get With The Guidelines program. “By three years, 38.1 percent of patients with an ICD had died compared to 52.3 percent of those without an ICD. Overall, patients receiving an ICD were 29 percent less likely to die in the first three years.”

The findings suggest that in older heart failure patients, age alone should not exclude patients who are otherwise appropriate for ICD treatment, Dr. Fonarow said. “There are substantial opportunities for clinicians to improve the evaluation and treatment of patients hospitalized with heart failure with reduced left ventricular ejection fraction,” he said.

Research shows that only 8 percent of older heart failure patients eligible for ICDs receive this clinically effective therapy prior to hospital discharge. “Previously, it was uncertain if ICDs improve survival in older patients with heart failure, as older patients had been underrepresented in clinical trials of ICDs,” Dr. Fonarow said. “Studying the use of ICDs in older patients and women is a high priority because of the size of the potential population at risk, continuing questions regarding effectiveness and the cost of these devices.”

Future research should evaluate health status, psychological distress and quality of life in older patients with heart failure after ICD therapy, Dr. Fonarow said. In addition, prospective studies are needed to evaluate the effects of health status on the decision to use ICD therapy and to analyze the clinical effectiveness of ICDs. “Large, randomized clinical trials have shown that ICDs reduce mortality in patients with reduced left ventricular ejection fraction, either with heart failure or after heart attack,” Dr. Fonarow said. “Reflecting this evidence, American Heart Association and American College of Cardiology guidelines recommend evaluation of systolic function in all patients with heart failure, and ICD therapy for patients with systolic dysfunction who meet certain criteria.”

Source: American Heart Association, December 15, 2009

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