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    Thursday, May 20, 2004

    Shocking Away Death: Two reports in today's New England Journal of Medicine suggest that implantable defibrillators improve the survival rate of patients with severe heart failure:

    Defibrillators and pacemakers save lives; in fact, the devices can save 9,000 Americans a year when combined with the best drug therapy, a national study led by a Colorado researcher shows.

    ....The 1,500 people in the study were tracked for three years. Those who received the pacemaker with drug therapy had a 19 percent decrease in both hospitalizations and deaths compared to those who got the drug therapy alone.

    Those who received both the pacemaker and defibrillator, plus the drug therapy, had a 36 percent decrease in mortality, compared to those who received just the drug therapy.

    The study subjects had advanced heart failure, the type of people who "maybe could walk around the block, but would be out of breath," Bristow said.

    The study funded by the defibrillator company Guidant, compared patients who took drugs alone with those who took drugs and had a standard pacemaker, and those who took drugs and had a combination pacemaker-defibrillator. All three groups were very similar in composition and disease state at the outset, although the drug-only group had a higher drop-out rate. (A significant number (26%) of them went on to have pacemakers and/or defibrillators put in when their medicines failed.) Death from any cause at the end of twelve months was 19% for the medicine only group, 15% for the regular pacemaker plus medicine group and 12% in the defibrillator group/medicine group. Death from heart disease at the end of twelve months was not given, but the rates of death or hospitalization due to heart disease were 60% in the medicine alone group, 45% in the pacemaker/medicine group and 44% in the defibrillator/medicine group. The authors don't explain why they didn't break the data down into overall deaths from cardiovascular disease. Could it be that the groups weren't as different in that respect?

    Could be. Another study in the same issue funded by St. Jude Medical, another producer of defibrillators, found that implantable defibrillators reduced the risk of death from an errant heart rhythm (which you would expect, since that's their purpose), but not the overall death rate.

    So, if you have severe heart failure is it worth having a defibrillator put in before you have problems? Or is it better to try medication first and then opt for a defibrillator if those fail? The defibrillator appears to give you an advantage in avoiding hospitalizations, but it doesn't seem to do much to prolong your life. Since most defibrillators cost around $20,000 (not including the cost of putting it in) it may not be worth it.

    posted by Sydney on 5/20/2004 07:54:00 AM 0 comments


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