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Defibrillator May Not Help Many With Heart Failure
Date:3/16/2009

even months. It dropped to about three months for those who had three hospitalizations for heart failure.

Survival time was extended by more than two years for heart failure patients who were younger than 65 and did not have kidney disease, cancer or dementia, the study found. But the average age of the people in the study was 77, and 21 percent had chronic kidney disease.

So, should the guidelines for implanting defibrillators in people with heart failure be changed?

"I wouldn't make such a recommendation based on our study," Setoguchi said. "I think we need more evidence. But our study is in line with other studies showing limited benefit in older people and those with comorbidities."

Data to make such a judgment might soon be available, said Dr. Paul Dorian, a professor of medicine at the University of Toronto and the author of an accompanying commentary on the journal report. Registries in the United States and Canada are tracking the results for people given implanted defibrillators, he said.

"That data is only just beginning to be analyzed," Dorian said. "When it is, we will then have a better feeling on whether patients getting defibrillators have results similar to those of the patients in the clinical trials that established their efficacy."

But the registry data might not allow a judgment because it covers only people given defibrillators, Setoguchi said. "We need concurrent information on patients with the same background and same comorbidities who didn't get defibrillators."

Meanwhile, cardiologists must make decisions every day on whether to give someone a defibrillator. And there's no easy way to make such a decision, both Setoguchi and Dorian said.

"What I do with patients is to try to talk as accurately and dispassionately as I can about their condition, the benefits and risks of defibrillators, and help them make their own conclusion," Dorian said. "I never say, 'You ne
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Defibrillator May Not Help Many With Heart Failure
Defibrillator May Not Help Many With Heart Failure
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