February 11, 2005

Defibrillator use cuts mortality rate: study

Featured Image

Mark Wathen, M.D.

Defibrillator use cuts mortality rate: study

In a study published recently in the New England Journal of Medicine more than 100 health care centers across the United States, including Vanderbilt University Medical Center, were able to prove that the use of defibrillators in heart failure patients reduced the mortality rate by 23 percent.

“What is known is that the most common cause of cardiac deaths is sudden death, which is especially true for congestive heart failure patients,” said Mark Wathen, associate professor of Medicine, who directed the study at VUMC.

“About half of these patients will die due to sudden death. Even though the patients in the trial did not have a history of arrhythmias (very fast heart rate), the point is you don't need a history — you simply have to have a weakened heart and heart failure symptoms.

“We wanted to see if preventative treatment would help save lives. And the answer is yes. We have a therapy that is nearly absolute for a problem that is so widespread and has a huge potential for saving lives — tens of thousands of lives. This finding is huge,” Wathen said.

In Tennessee there is a 97 percent mortality rate due to arrhythmias, Wathen said. If there is a way to prolong life, he and his colleagues want to offer it to patients.

VUMC is the only hospital in the Midstate to participate in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).

The study followed more than 2,500 heart failure patients over a course of four years. Patients were randomized to three different groups: standard therapy, which might include bypass; stent placement or prescriptive drugs; arrhythmia drug therapy; and using a single-lead, shock-only implantable cardioverter defibrillator (ICD).

The outcome of the trial showed that the use of defibrillators reduced mortality by 23 percent, while the drug therapy did nothing to prevent deaths. The mortality rate was only 7.2 percent after five years in the overall population.

Since the study concluded, federal officials have ruled that Medicare will reimburse for the therapy, eliminating a primary concern of the study's participating investigators.