Older people with comorbidities and those with multiple hospital admissions related to heart failure are unlikely to receive a meaningful survival benefit from implanted defibrillators, found a study in CMAJ by researchers from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts.
The cohort study looked at more than 14 000 patients with heart failure using an administrative database over 5 years. The mean age of the group was 77 years, and patients had a high level of comorbidities such as other cardiovascular disease, diabetes, chronic pulmonary disease and kidney disease.
Survival declined progressively after repeated hospital admissions and implantable defibrillators would have apparently extended life by just over 6 months. However, patients under 65 years of age and older patients without kidney disease, cancer or dementia would be most likely to benefit from implantable defibrillators to prevent sudden death.
"In contrast to our observations, information from the US National Cardiovascular Data Registry for 2006-2007 indicates that implantable defibrillators are frequently implanted in older patients with heart failure: 61% of patients were 65 years or older, and 15% were 80 years or older," write Dr. Soko Setoguchi and coauthors. Fifty-eight percent of patients had previously been admitted to hospital and comorbidities were common.