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 More than 20 percent of patients with frailty or dementia died
within a year of getting defibrillators, which means they likely
didn't benefit from the devices, researchers found.
"If someone has a 20 percent risk of dying in one year, we’re not
sure if they’ll benefit from a defibrillator," said lead author Dr.
Ariel Green, of Johns Hopkins University in Baltimore.
Implantable cardioverter-defibrillators, or ICDs, are placed under
the skin and attached to the heart. The devices use shocks to
restore normal heartbeats in people known to have life-threatening
irregular rhythms that could result in sudden death.
ICDs are not the same as pacemakers, which can't deliver the same
kind of high-energy shocks to the heart. Shocks from an ICD, by
contrast, can feel like a kick in the chest.
Over 140,000 ICDs are implanted in the U.S. each year, and about 40
percent are given to people at least 70 years old, the researchers
write in Circulation: Cardiovascular Quality and Outcomes. Yet there
is limited information on how older patients with other medical
problems fare with ICDs.
For the new study, the researchers used data from nearly 84,000
people who received an ICD and were enrolled in Medicare, the U.S.
government health insurance for older and disabled adults.
About one in 10 of the ICD recipients had dementia or frailty, which
is generally a marker of overall health.
About 12 percent of patients who received an ICD died within one
year, but that rate was much higher for people with frailty or
dementia.
In fact, Green said, frailty and dementia seemed to predict risk of
death better than other health problems.
In patients with frailty, 22 percent died within one year of getting
an ICD. Of those with dementia, 27 percent died within a year.
Almost a third of patients with both conditions died within a year
of getting ICDs.
Similar rates of death were seen among the 8 percent of patients
with other complex health conditions, like frailty and chronic
obstructive pulmonary disease, and frailty with diabetes.
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The increased risk of death is likely not due to the ICDs, said
Green. Instead, it's likely due to the patients' overall health.
The findings, she said, suggest that people need to be very careful
in their decision-making about ICDs, and they need to take frailty
into account.
Dr. Oussama Wazni, who wasn't involved in the new study, said he
thinks doctors already consider these factors when recommending
treatment for their patients.
"Patients and their family members should have realistic
expectations - especially in this group of patients that have
frailty and dementia," said Wazni, director of the Outpatient
Electrophysiology Department and co-director of the Ventricular
Arrhythmia Center at the Cleveland Clinic.
"We want to make sure the family members and the patient understand
we only recommend a procedure when the benefit is more than the risk
in all instances," he said.
One of the next steps is to identify which patients would likely
fall into the 20 percent who will die within a year, Wazni told
Reuters Health.
Green also told Reuters Health that databases that track people with
ICDs should include frailty and dementia to assist future research.
SOURCE: http://bit.ly/1QYpZEi Circulation: Cardiovascular Quality
and Outcomes, online December 29, 2015.
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