Heart attack patients age 65 and older who have reduced heart function might still benefit from implanted defibrillators, according to a Duke Medicine study published in the Journal of the American Medical Association (JAMA). But fewer than 1 in 10 eligible patients actually get a defibrillator within a year of their heart attacks, the study found.
Advanced age, transitions in care between the hospital and an outpatient clinic, and a mandatory waiting period to get a defibrillator after a heart attack were the most likely factors for low rates of use, 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.
Defibrillators are life-saving therapies that have a lot of evidence supporting their use,” said Tracy Wang, MD, associate professor of medicine (Cardiology) 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.”
“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.”
“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, MD, a Duke cardiology fellow 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.”