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Lauren Dubinsky, Senior Reporter | June 25, 2015
Even though heart attack patients 65 years and older may benefit from implanted defibrillators, fewer than one in 10 eligible patients actually get them within a year of their heart attacks, according to a new Duke University School of Medicine study.
Factors contributing to this issue may be advanced age, transitions in care between the hospital and outpatient clinic and a mandatory waiting period to get a defibrillator after a heart attack, according to the study.
The researchers collected data from 10,318 older heart attack patients from 441 hospitals across the U.S. participating in a National Cardiovascular Data Registry. They didn’t expect 100 percent of the patients to use defibrillators, but they were surprised at how few patients with reduced heart function actually had them.
“Defibrillators are lifesaving therapies that have a lot of evidence supporting their use,” Dr. Tracy Wang, senior author of the study and associate professor of cardiology at the university, said in a statement. “But not every older patient wants one.”
She said that there is a trade-off between the risks and benefits of the device and there is also a big debate from a quality-of-life perspective. “For older patients who are debilitated, providing a defibrillator could simply extend a low quality of life,” she added.
Most of the clinical trials on defibrillators involved devices that have been in use since the 1980s and focused on patients in their 60s. Because of that, the benefits of defibrillator use in older adults are not well established.
But regardless, defibrillators have proven benefits. The Duke study found that patients who had defibrillators implanted had a one-third lower risk of death after two years than those who didn’t have a defibrillator.
A major potential hurdle to widespread defibrillator use may be a gap in care when the patients need the device. Current guidelines recommend that patients wait at least 40 days after their heart attack to get a defibrillator but a lot can happen in that time frame.
Patients who stay connected with their cardiologists and continue to attend follow-up appointments are more likely to get the defibrillators. Primary care physicians might not be aware of the patient’s reduced heart function or may think that the patient’s older age would make them a poor candidate for a defibrillator.
The researchers cautioned that additional research is needed to determine evidence-based approaches to defibrillator use in eligible patients and practices that promote close patient follow-up and communication.
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