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Study: Implanted defibrillators often overused

January 4, 2011 12:00:00 AM PST
A first of its kind analysis says one in five heart defibrillators may be implanted without solid evidence that the devices will help. The Duke University study says the devices do not benefit these patients and it's costly.But for many, it's a life saver.

Five years ago, Bonnie Kyle got some bad news about her husband's cancer.

"I loved my husband madly and I was just so deeply saddened at the news that he was not going to live that my body went into shock," said Kyle.

She went into full cardiac arrest. Doctors resuscitated her and she received an implantable cardioverter-defibrillator or ICD. It monitors her heart and sends electrical signals to keep it steady.

"She is the perfect example of a healthy person living a good quality of life that's been saved by a defibrillator," said Dr. David Mok, a cardiac electrophysiologist at Providence St. Joseph Medical Center.

But cases aren't always as clear-cut as Kyle's. Dr. Mok says most ICD patients haven't had a cardiac event.

There are specific guidelines as to who should get one. According to Dr. Mok, patients should not receive a preventative or primary prevention defibrillator within 40 days of a heart attack. Someone recently diagnosed with congestive heart failure shouldn't get one and patients shouldn't get one within 3 months of having coronary bypass surgery.

Now, a new study examines how well doctors follow these guidelines.

Of the 100,000 people who received ICDs, researchers say more than 20 percent did not meet the specific medical criteria.

And these patients may be at higher risk for complications including death. But Dr. Mok points out guidelines are just that, and a good doctor weighs all the options before making a recommendation.

"The evidence based guidelines are the best knowledge that we have for good care. However there are still situations where you may be outside of the guidelines in which an ICD could be beneficial and appropriate," said Dr. Mok.

"I think you have to trust your doctors and just be proactive about your doctor care," said Kyle.

Study authors noted electrophysiologists or doctors with special training in heart rhythms had slightly better rates of evidence-based implants than other types of doctors in the study.

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