Older Patients and Implantable Defibrillators

By Sondra Forsyth

Fewer one in 10 heart attack patients over 65 get an implantable defibrillator within a year of their heart attacks, according to a study from Duke Medicine.

The most likely reasons for the low rate included advanced age, transitions in care between the hospital and an outpatient clinic, and a mandatory waiting period to get a defibrillator, according to the study.

Defibrillators shock hearts back to pumping when a patient experiences a potentially fatal sudden cardiac arrest. Prior studies have primarily shown benefits to using these devices in younger patients.

The study was published in the Journal of the American Medical Association.

“Defibrillators are life-saving therapies that have a lot of evidence supporting their use,” said Tracy Wang, M.D., an associate professor of cardiology at the Duke University School of Medicine and senior author of the study. “But not every older patient wants one. There is a trade-off between the risks and benefits of the device. But current data suggests that we are grossly underutilizing this therapy.”

According to a news release from Duke Medicine, the researchers expected less than 100 percent usage of the devices, but were surprised at how few of the 10,318 heart attack patients actually received them.

The patients were an average of 78 years old, and 44 percent of them were more than 80 years old. Most previous clinical trials on defibrillators have focused on patients in their 60s, Wang said, so the benefits of defibrillator use in older adults are not well established.

“This is a big debate from a quality-of-life perspective,” Wang said. “The decision about defibrillators has to be individualized. For older patients who are debilitated, providing a defibrillator could simply extend a low quality of life.”

In their study, the researchers also considered another potential barrier to their use – a gap in care at a time when patients are most vulnerable.

“The optimal timing for implanting a defibrillator is still in question, but current guidelines recommend that patients wait at least 40 days after their heart attack,” said Sean Pokorney, M.D., a cardiology fellow at the Duke University School of Medicine and lead author of the study. “If the patient’s heart is still having trouble pumping blood after 40 days, they would be eligible. But a lot can happen in that 40 days.”