Implantable defibrillators save older patients too

By Julie Steenhuysen

CHICAGO (Reuters) - Implantable heart defibrillators — which have been found to save lives in younger patients — appear to have the same benefit for people over 70, U.S. researchers said on Tuesday.

The study suggests the devices, known as implantable cardioverter defibrillators or ICDs, should be offered to people in their 70s despite some recent studies questioning their use in older patients.

“There does not appear to be a difference in benefit between younger and older patients,” said Dr. Paul Chan of the University of Missouri in Kansas City, whose study appears in the journal Circulation: Cardiovascular Quality and Outcomes.

“We need to ensure we avoid undertreatment of older patients,” he said in a telephone interview.

Implantable defibrillators are tiny devices implanted under the skin with wires leading to the heart. The devices detect dangerous heart rhythms and shock the heart back into a normal rhythm. They are often used in people who have damaged heart tissue that reduces the heart’s ability to pump blood — a group at high risk for life-threatening heart rhythms.

Chan said other clinical trials of ICDs have focused on younger, healthier patients. Medicare, the U.S. federal health plan for the elderly, greatly expanded its coverage of the devices in 2005.

“What we really wanted to do is provide some insight into what is the benefit of patients in their 70s,” he said.

Older, sicker patients are often excluded from clinical trials, but recently research teams have begun looking at this population.

Earlier this year, a study in the New England Journal of Medicine found that treating high blood pressure in people over 80 reduced the risk of fatal strokes and other heart problems.

Chan and colleagues studied 986 patients with heart damage from March 2001 to June 2005. About half got an ICD. All had low heart pumping function and many had other conditions, such as diabetes.

The average age of the study group was 67 — about three to seven years older than two large clinical trials of the devices, Chan said.

Overall, the devices reduced deaths from any cause by 30 percent — a rate similar to that in studies of younger patients. Chan said the benefit was less for those over 75 who had other significant health problems.

The researchers said while decisions about the use of ICDs should be based on the needs of individual patients, the findings suggest that older patients should not be “routinely excluded from consideration for ICD implantation.”

Chan has no ties with ICD makers but some of his colleagues on the paper have ties with Medtronic Inc, St. Jude Medical Inc , Boston Scientific Corp and others.

(Editing by Maggie Fox and Cynthia Osterman)


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