Defibrillator Use After Myocardial Infarction in Older Adults

Defibrillator Use After Myocardial Infarction in Older Adults

According to current estimates, more than 350,000 people experience sudden cardiac death in the United States each year. Patients with low ejection fraction (EF) are at risk for sudden cardiac death, and clinical trials have established that implantable cardioverter-defibrillators (ICDs) improve survival for these individuals. Guidelines recommend ICDs as primary prevention for patients with an EF of 35% or lower if they do not improve after being treated with optimal medical therapy for at least 40 days after a myocardial infarction (MI). Studies suggest that ICDs are underutilized in routine clinical practice, especially after a patient suffers an MI. The incidence of MI and the resulting sequelae from these events increase with age. The benefit of ICDs as primary prevention is controversial among older patients because this population is underrepresented in clinical trials. Clinicians may be uncertain about the efficacy of ICDs in an older patient population and must also consider treatment goals and procedural risks. These factors may discourage the use of ICDs among older adults.   A Closer Look In a retrospective study published in JAMA, Sean D. Pokorney, MD, MBA, and colleagues examined data from Medicare beneficiaries with an EF of 35% or less after MI. Participants were treated at 441 U.S. hospitals between 2007 and 2010, but were excluded if they had a prior ICD implant. The investigators evaluated the incidence and hospital variation of 1-year ICD implantation after MI among potentially eligible patients. They also examined factors that were linked to 1-year ICD implantation and compared 2-year mortality between patients with and without ICDs. The study was unique in that it evaluated the use...

Gender & Heart Failure Survival

Women with heart failure (HF) appear to have better survival than men irrespective of ejection fraction, according to a large meta-analysis. The mortality rate for women with HF was 25%, compared with 26% for men with HF, during 3 years of follow-up. In those with non-ischemic, compared with ischemic, disease, the better prognosis associated with female gender was more marked.  Abstract: European Journal of Heart Failure, May...