Implantable cardioverter-defibrillators offer lifesaving benefits, return to active life, and reduced cost

Researchers at the University of Pennsylvania's School of Medicine have discovered that implantable cardioverter-defibrillators (ICDs) -- electric monitoring devices that deliver a lifesaving shock in the event of a cardiac arrest -- help patients with heart problems live longer more active lives.

Further, the study found most patients living with ICDs enjoy a quality of life consistent with average Americans their age and have a high level of satisfaction with the device, offsetting longstanding perceptions that the technology extends but seriously impairs patients' lives. Peter Groeneveld, M.D., M.S., Assistant Professor of General Internal Medicine and his co-authors report their findings in the April 2007 issue of the journal Pacing and Clinical Electrophysiology.

The study is the first to analyze quality of life and cost in "primary prevention" ICD patients, that is patients with no prior history of abnormal heart rhythms, but whose heart disease may increase their risk of sudden cardiac death. It is also among the first to verify the effectiveness of ICDs in patients who were not enrolled in clinical trials.

The use of ICDs has rapidly increased in recent years, particularly since Medicare and other health payers expanded coverage of the device for primary prevention. Nearly 50,000 implants were performed in 2005 in the United States, alone, making it among the most common cardiovascular device used in contemporary clinical practice.

"While the lifesaving benefits of ICDs have been well documented over the last decade, little was known about the experience of patients in the real world post implantation. This study looked at a population that better represents current device recipients, which in turn, means that physicians can now communicate a more accurate description about life with the device to patients," said Groeneveld.

Researchers administered a comprehensive patient survey to better understand quality of life benefits, for both primary prevention and "secondary prevention" ICD patients, i.e., patients who have already experienced a cardiac event.

Key findings include:

• Patients living with an ICD report high levels of emotional, physical and functional well-being, and are satisfied and able to adapt to living with the device.
• When analyzed against a control population, their experiences are comparable to average Americans of the same age.
• Driving, lifting heavy objects and sexual activity were the most common lifestyle concerns voiced by ICD patients during the quality of life survey, suggesting that physicians should routinely address these issues with patients when communicating expectations of living with the device and throughout long-term care.

According to Groeneveld, the quality of life benefits emerge from advances in ICD technology over the last decade resulting in smaller, more easily programmed devices which can more accurately respond to the needs of the individual patient.

"With an estimated one million Americans eligible for implantation today, it is extremely important to verify that ICDs deliver value on par with the health care dollars expended in most heart patients, even among the elderly," he said.

http://www.med.upenn.edu/