ICD: New study shows low use, high benefit in older HF patients

A new study released in the Journal of the American Medical Association today reported that implantable cardioverter-defibrillators may be underutilized in elderly patients.

Data from the 10,318-patient study, partially supported by Boston Scientific (NYSE:BSX), revealed that only 8.1% of eligible patients over 65 received ICDs within 1 year after experiencing a heart attack, despite the fact that implantation was associated with a 33% lower 2-year mortality rate.

“We looked at the association between receiving an ICD and death to compare the benefit for patients over the age of 80 with the same benefit for patients under the age of 80 and we found that there’s really a consistent benefit for ICD therapy across both age groups,” lead author Sean Pokorney, of the Duke University School of Medicine told MassDevice.com.

Pokorney said that current guidelines, which recommend a 40-day waiting period after a heart attack before ICD implantation, may be having a negative effect on implantation rates.

“The optimal timing for implanting a defibrillator is still in question, but current guidelines recommend that patients wait at least 40 days after their heart attack. If the patient’s heart is still having trouble pumping blood after 40 days, they would be eligible. But a lot can happen in that 40 days,” Pokorney said in a press release.

Pokorney said the study looked at patients during that 40-day period to see if they were healing, and no longer required ICDs.

“One of our questions was, are our patients hearts recovering? We know from historical data that it happens, but it’s relatively uncommon. So we looked at patients who had the largest heart attacks; patients who had the weakest hearts at the time of their heart attack; patients that are least likely to have recovery of heart function. Even among these patients, the rates of ICD implantation were about 1 in 10,” Pokorney said.

How often patients interact with their clinicians and health care workers affects the rate of ICD implantation as well, Pokorney said.

“One of the key findings was that patients who had more contact with the healthcare system were more likely to receive ICDs,” Pokorney said. “That was seen in the form of early cardiology follow-ups. Patients who have cardiology visits within 2 weeks of their heart attack have higher rates of ICD implantations. Patients that came back to the hospital for heart attacks of heart failure had higher rates as well.”

Pokorney said that while no one expects a 100% implantation rate, an increase in implantation rate among older patients could save lives.

“I think one thing that providers should understand is that this study shows that age alone should not be a contraindication to ICD implantation,” Pokorney said. “Even though we may need to refine our patient selection process, and who will benefit the most, we don’t feel that age should be a contraindication.”

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