Thursday, February 5, 2009

New study finds approximately 20% of eligible heart failure patients get defibrillators
By Kelly Winget, DCRI Communications

An analysis of the Get With the Guidelines (GWTG) Heart Failure registry indicates that despite evidence-based guidelines, many eligible heart failure patients do not receive implantable cardioverter defibrillators (ICD) that would shock the heart back to normal rhythm when necessary.

The American Heart Association publishes the GWTG Heart Failure registry.

The study, led by the DCRI's Bimal Shah, MD, MBA, was published in the February 3 issue of the Journal of the American College of Cardiology.

Defibrillators can be an important part of helping to prevent heart attacks or death for patients with heart failure. Some informal observations have indicated that the therapy is not used as often as it could be, and the GWTG registry analysis found that overall use of defibrillators was only 20 percent among patients that fit the therapy guidelines and who would likely benefit from the device.

Researchers also found that medical centers that are affiliated with academic institutions, and those that have the capability to perform heart transplant surgeries and surgeries to insert stents to widen coronary arteries, are more likely to more closely follow the guidelines for when to implant defibrillators. However, only 36 percent of potentially eligible patients in these centers received ICD therapy.

Researchers reviewed data on more than 10,000 patients who were admitted to 34 hospitals for acute heart failure from 2005 to 2007. The hospitals were all participating in the GWTG program. All of the patients had chronic heart failure and had not previously received a defibrillator.

Because these medical centers are voluntarily participating in the GWTG Heart Failure program, researchers note that these centers might be more likely to comply with guidelines for ICD therapy. Researchers also noted that there are questions about whether ICD therapy should be included as part of quality-of-care metrics or not, as well as some concern about exactly who should receive defibrillators and when they should be implanted.

Researchers said further studies about the safety and benefits of using defibrillators in elderly patients or patients who have other existing health conditions could help improve adoption with guidelines.