January 20, 2005
A new study (Sudden Cardiac Death in Heart Failure Trial, or SCD-HeFT), published in the January 20 New England Journal of Medicine* found that implantable cardiac defibrillators reduce the risk of death from sudden cardiac arrest by 23 percent in patients with heart failure. The Cleveland Clinic Foundation, along with Medical Centers nation-wide studied more than 2,500 patients with NYHA class II or III heart failure (symptoms with either ordinary or less than ordinary physical activity) and an ejection fraction of 35 percent or less (The ejection fraction is a measurement of how much blood is being pumped out of left ventricle of the heart. A normal person has an ejection fraction of about 55 percent).
Heart failure is a condition where the heart is no longer pumps efficiently, leading to a host of complications. Among these complications are abnormal heart rhythms, such as sudden cardiac arrest (SCA), which can be lethal if not treated immediately. SCA, or loss of the heart’s ability to pump due to a rapid chaotic heart rhythm in the ventricles (lower heart chambers), is responsible for 60 percent of deaths among mild to moderate heart failure patients. An implantable defibrillator (ICD) monitors the patient’s heart rhythm, senses when these abnormal rhythms become life threatening, and delivers an electric shock that restores the normal rhythmic pattern.
Although the initial presentation of the SCD-HeFt results occurred in March of 2004, Medicare carefully deliberated and waited to expand the use of implantable defibrillators for patients at risk of sudden cardiac death until after the January 20, 2005 publication. This means that more Americans can get this life-saving treatment, and that the government health agency will pay for it. Medicare had formerly paid for the device only under much fewer circumstances.
The benefits of the implantable defibrillators were clear to medical experts, like Bruce Wilkoff, M.D., head of Cardiac Pacing and Tachyarrhythmia Devices at the Cleveland Clinic Heart Center. “More people die every year in the United States from serious fast heart rhythms than from any other cause,” he says. “Implantable defibrillators have the ability to rescue patients from these heart rhythms.”
In fact, in 2001 a study of the devices was cut short, because the devices were so overwhelmingly successful in saving patients who had suffered previous heart attacks and had weakened heart muscles.
Studies, such as SCD-HeFT, are important to provide evidence-based, effective therapies for patients with heart failure. A variety of devices are available to improve the outcomes of patients with heart failure. These include the ICD, combined ICD and pacemaker, combined ICD and biventricular pacemaker.
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©Cleveland Clinic Foundation 1/05
