Implantable Cardioverter-defibrillators Underused Among Older Patients
Durham, NC - Among Medicare patients who experienced a heart attack from 2007 to 2010, fewer than 1 in 10 eligible patients with low ejection fraction (a measure of how well the left ventricle of the heart pumps blood with each beat) received an implantable cardioverter-defibrillator (ICD) within 1 year after the heart attack, even though ICD implantation was associated with a lower risk of death at 2 years after implantation, according to a study in the June 23/30 issue of JAMA.
More than 350,000 people experience sudden cardiac death in the United States annually. Clinical trials have established the benefit of primary prevention ICDs among patients with low ejection fraction (EF). ICDs are not recommended within 40 days of a myocardial infarction (MI; heart attack). Given this need to wait, ICD consideration is susceptible to errors of omission during the transition of post-MI care between inpatient and outpatient care teams. In addition, uncertainties regarding ICD effectiveness, along with other considerations of treatment goals and procedural risk, may discourage ICD implantation among older adults, according to background information in the article.
Sean D. Pokorney, M.D., M.B.A., of the Duke University Medical Center, Durham, N.C., and colleagues examined ICD implantation rates and associated mortality among Medicare beneficiaries with an EF of 35 percent or less after MI, treated at 441 U.S. hospitals between 2007 and 2010. Follow-up data were available through December 2010.
The final study population included 10,318 post-MI patients (median age, 78 years) who were potentially eligible for primary prevention ICD implantation. The cumulative 1-year ICD implantation rate among the patients was 8.1 percent. Patients who received an ICD within 1 year after MI were younger and were more likely to be male; to have larger infarcts (area of damage in heart caused by impaired circulation), prior coronary artery bypass graft procedures (31 percent vs 20 percent), and evidence of cardiogenic shock (shock due to low blood output by the heart) during index hospitalization (13 percent vs 8 percent), relative to patients who did not receive an ICD within 1 year. Continue>
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