User login
Fewer than one in 10 elderly patients with a low ejection fraction after myocardial infarction who are eligible to receive an implantable cardioverter-defibrillator actually receive one within a year of their myocardial infarction, a study has found.
The retrospective observational study of 10,318 patients aged over 65 years who had experienced a myocardial infarction and had an ejection fraction of 35% or less showed only 8.1% received an implantable cardioverter-defibrillator (ICD) within a year of their MI, even though implantation within a year was associated with a 36% reduction in mortality at 2 years.
Those patients who did receive an ICD were more likely to have had a prior coronary artery bypass graft, had higher peak troponin levels, experienced in-hospital cardiogenic shock, or had a cardiology follow-up within 2 weeks of discharge, according to the paper published June 23 in JAMA.
“Individualized shared decision making, taking into context the patient’s quality of life, treatment goals, and preferences, is critical, because ICD therapy may shift death from a sudden event to a more gradual comorbid process,” wrote Dr. Sean D. Pokorney, of Duke University Medical Center, Durham, N.C., and co-authors (JAMA 2015;313:2433-40 [doi: 10.1001/jama.2015.6409]).
The study was supported by the Agency for Healthcare Research& Quality, and Boston Scientific. Some authors declared research grants, honoraria, advisory board positions, and consultancies with private industry.
It is concerning that so few potentially ICD-eligible elderly patients are undergoing implantation, especially considering that ICDs significantly improve survival.
A possible scenario is that many of these patients did not receive an appropriate ICD simply because they fell into a crevasse of the fragmented health system in which overly burdened primary care physicians are expected to connect all the clinical and diagnostic information without the essential tools and necessary facts.
Dr. Robert G. Hauser is affiliated with the Minneapolis Heart Institute at the Abbott Northwestern Hospital. These comments are taken from an accompanying editorial (JAMA 2015;313:2429-31 [doi:10.1001/jama.2015.6408]). No conflicts of interest were declared.
It is concerning that so few potentially ICD-eligible elderly patients are undergoing implantation, especially considering that ICDs significantly improve survival.
A possible scenario is that many of these patients did not receive an appropriate ICD simply because they fell into a crevasse of the fragmented health system in which overly burdened primary care physicians are expected to connect all the clinical and diagnostic information without the essential tools and necessary facts.
Dr. Robert G. Hauser is affiliated with the Minneapolis Heart Institute at the Abbott Northwestern Hospital. These comments are taken from an accompanying editorial (JAMA 2015;313:2429-31 [doi:10.1001/jama.2015.6408]). No conflicts of interest were declared.
It is concerning that so few potentially ICD-eligible elderly patients are undergoing implantation, especially considering that ICDs significantly improve survival.
A possible scenario is that many of these patients did not receive an appropriate ICD simply because they fell into a crevasse of the fragmented health system in which overly burdened primary care physicians are expected to connect all the clinical and diagnostic information without the essential tools and necessary facts.
Dr. Robert G. Hauser is affiliated with the Minneapolis Heart Institute at the Abbott Northwestern Hospital. These comments are taken from an accompanying editorial (JAMA 2015;313:2429-31 [doi:10.1001/jama.2015.6408]). No conflicts of interest were declared.
Fewer than one in 10 elderly patients with a low ejection fraction after myocardial infarction who are eligible to receive an implantable cardioverter-defibrillator actually receive one within a year of their myocardial infarction, a study has found.
The retrospective observational study of 10,318 patients aged over 65 years who had experienced a myocardial infarction and had an ejection fraction of 35% or less showed only 8.1% received an implantable cardioverter-defibrillator (ICD) within a year of their MI, even though implantation within a year was associated with a 36% reduction in mortality at 2 years.
Those patients who did receive an ICD were more likely to have had a prior coronary artery bypass graft, had higher peak troponin levels, experienced in-hospital cardiogenic shock, or had a cardiology follow-up within 2 weeks of discharge, according to the paper published June 23 in JAMA.
“Individualized shared decision making, taking into context the patient’s quality of life, treatment goals, and preferences, is critical, because ICD therapy may shift death from a sudden event to a more gradual comorbid process,” wrote Dr. Sean D. Pokorney, of Duke University Medical Center, Durham, N.C., and co-authors (JAMA 2015;313:2433-40 [doi: 10.1001/jama.2015.6409]).
The study was supported by the Agency for Healthcare Research& Quality, and Boston Scientific. Some authors declared research grants, honoraria, advisory board positions, and consultancies with private industry.
Fewer than one in 10 elderly patients with a low ejection fraction after myocardial infarction who are eligible to receive an implantable cardioverter-defibrillator actually receive one within a year of their myocardial infarction, a study has found.
The retrospective observational study of 10,318 patients aged over 65 years who had experienced a myocardial infarction and had an ejection fraction of 35% or less showed only 8.1% received an implantable cardioverter-defibrillator (ICD) within a year of their MI, even though implantation within a year was associated with a 36% reduction in mortality at 2 years.
Those patients who did receive an ICD were more likely to have had a prior coronary artery bypass graft, had higher peak troponin levels, experienced in-hospital cardiogenic shock, or had a cardiology follow-up within 2 weeks of discharge, according to the paper published June 23 in JAMA.
“Individualized shared decision making, taking into context the patient’s quality of life, treatment goals, and preferences, is critical, because ICD therapy may shift death from a sudden event to a more gradual comorbid process,” wrote Dr. Sean D. Pokorney, of Duke University Medical Center, Durham, N.C., and co-authors (JAMA 2015;313:2433-40 [doi: 10.1001/jama.2015.6409]).
The study was supported by the Agency for Healthcare Research& Quality, and Boston Scientific. Some authors declared research grants, honoraria, advisory board positions, and consultancies with private industry.
FROM JAMA
Key clinical point: Many elderly patients who are eligible for an implantable cardioverter-defibrillator after a myocardial infarction are not receiving them.
Major finding: Only 8.1% of older patients with an ejection fraction of less than 35% after a myocardial infarction receive an implantable cardioverter-defibrillator.
Data source: Retrospective observational study of 10,318 patients aged over 65 years.
Disclosures: The study was supported by the Agency for Healthcare Research & Quality, and Boston Scientific. Some authors declared research grants, honoraria, advisory board positions, and consultancies with private industry.