Alan Kadish, M.D., associate chief of Cardiology at Northwestern Memorial Hospital and associate director of the Northwestern Cardiovascular Institute, authors an editorial entitled "Prophylactic Defibrillator Implantation – Toward Evidence-Based Approach," which accompanies the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) reported in the January 20 edition of the New England Journal of Medicine.
"This is the second large-scale study to suggest that heart failure patients without coronary artery disease who receive ICDs, implantable cardioverter-defibrillators, have a better outcome than those treated with medical therapies," according the Dr. Kadish. "This study confirms the effectiveness of ICDs in preventing sudden cardiac death."
Dr. Kadish was an investigator on the only other large study previously done to examine the ability of ICDs to decrease mortality among patients with heart failure. The Defibrillators in NonIschemic Cardiomyopathy Treatment Evaluation (DEFINITE) showed a relative 35 percent decrease in overall mortality with the use of ICD therapy. In SCD-HeFT, there was a 27 percent relative decrease in mortality among these patients. The results of these two studies are broadly consistent.
"While ICDs are expensive, results of this trial, combined with those of DEFINITE show that they are indeed cost-effective when used in the appropriate population," explains Dr. Kadish. "Patients with an ejection fraction – the percentage of blood that is pumped out of a filled ventricle with each heartbeat – of less than 31 percent should be considered for a single-chamber ICD. Patients with an ejection fraction of 31 to 40 percent pose a more difficult treatment challenge, and these patients will require additional testing and evaluation to determine whether a prophylactic ICD would be beneficial. The results of studies completed in the last year will increase the number of patients who can benefit from life-saving therapy with an ICD."
More research will need to be done to determine if the benefit of the ICD is more marked in patients with less severe congestive heart failure.
Materials provided by Northwestern Memorial Hospital. Note: Content may be edited for style and length.
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