Implantable Defibrillators Lower Risk of Death in Older Hear...(ed through March 2007. Researcher...),Health

Researchers compared outcomes of 500 patients who received ICDs to those who didn't receive the devices. The median age of patients was 67. This was about seven years older than participants in an earlier study that investigated the use of ICDs in patients with heart failure (the SCD-HeFT trial) and about three years older than participants in a study that reported on the use of ICDs in patients who had heart attacks (the MADIT-2 trial).

Researchers said theirs was one of the first studies to examine whether the benefits of ICDs from controlled clinical trials apply to real-world patients. Their study was also the first to examine a clinically well-characterized primary prevention group with patients of both ischemic and non-ischemic causes of heart damage with more than three years of follow-up.

"We sought to determine the effectiveness of ICDs in real-world patients who are older and have multiple co-existing illnesses," Chan said.

Overall, 238 deaths occurred --- 130 (26.7 percent) in the non-ICD group and 108 (21.6 percent) in the ICD group. Of these, 116 were attributed to arrhythmia --- 67 (13.7 percent) in the non-ICD group and 49 (9.8 percent) in the ICD group.

"The ICD reduced all-cause mortality by 30 percent compared with patients who didn't receive ICDs," Chan said. "The use of ICDs in general practice reduced mortality similar to the levels seen in clinical trials. And, the use of ICDs in older patients and patients with comorbidities reduced mortality both in relative and absolute terms."

When researchers studied patients age 75 or older, they found that the level of survival benefit remained intact. But the benefit diminished when age was combined with multiple disease conditions.

The caveat, Chan said, was that "cost effectiveness estimates for ICD therapy in this study population depended upon both
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