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ICD use improves long-term survival in older heart failure patients

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In elderly heart failure patients with ejection fractions of 35% or less, implantable cardioverter defibrillators (ICD) can significantly improve long-term survival, according to a report in the December 15th online issue of Circulation: Heart Failure.

In general, the authors say, patients with low left ventricular ejection fractions (LVEF), whether from heart failure or myocardial infarction (MI), do better with ICDs. But while patients older than 65 account for more than 70% of heart failure cases, they are underrepresented in ICD trials, and so the effectiveness of ICDS has not been clearly established for this group.

Dr. Gregg C. Fonarow, from UCLA Medical Center, Los Angeles, and his co-authors addressed this question by analyzing data from 4685 patients, 65 years and older, who participated in the OPTIMIZE-HF study and the Get With The Guidelines-Heart Failure quality-improvement program.

Patients were enrolled if they were discharged alive from a hospitalization for new or worsening heart failure. In each case, the patient had an LVEF no higher than 35% and was eligible for an ICD. Long-term outcomes were assessed by matching the patients to Medicare claims. The main endpoint was all-cause mortality over 3 years.

Overall, 60% percent were women, the mean age was 75.2 years, and the mean LVEF was 25%. During the index hospitalization, 376 patients (8.0%) received ICDs.

At all points during follow-up, mortality was significantly lower in patients with ICDs (19.8% vs. 27.6% at 1 year, 30.9% vs. 41.9% at 2 years, and 38.1% vs. 52.3% at 3 years).

All told, the authors calculate that ICD use reduced the risk of death at 3 years by 29%.

“Our findings, which reflect the experiences of a mix of patients with ischemic and nonischemic heart failure in the community, suggest that ICDs are clinically effective in older patients with heart failure up to age 84 years,” the researchers conclude.

Circulation: Heart Failure 2009.