Defibrillators Implanted Before Heart Attacks Can Prevent Sudden Cardiac Death

Defibrillators implanted in patients who have some types of heart disease, but have not yet had a heart attack, can prevent sudden cardiac death. That was the finding of a recent study conducted by a consortium of institutions, including NYU Medical Center. Smaller studies had suggested this finding, but this was the largest and longest-term study, conclusively proving the benefit of defibrillators for this purpose.

Traditionally, defibrillators have been implanted in patients who have already endured a major form of heart failure. These small electrical devices can shock the heart back into a normal rhythm when the heart starts to beat erratically. But this study showed that implanting the defibrillator earlier—in patients with all kinds of heart disease who are at risk for a major heart attack—decreased their death rate by 23 percent.

The study, published in The New England Journal of Medicine, involved 2,521 patients at 150 institutions, whose condition was followed for up to six years.
 
As a result of this trial, the Centers for Medicare and Medicaid Services has stated that it will expand insurance coverage for defibrillators, which cost on the order of $30,000. Eligibility will be extended to patients whose left ventricle expels less than half of the normal amount of the blood within it per beat. Patients with this reduced heart-pumping capacity are estimated to number about 600,000 in the U. S.

“We expect that with this expanded coverage for defibrillators, we will substantially reduce the incidence of sudden cardiac death,” says Larry A. Chinitz, M.D., Associate Professor of Medicine and Director of Invasive Cardiology and Cardiac Electrophysiology, who led the NYU team’s involvement in this trial and helped design the study’s protocol.