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Shock to heart points to more woe

Defibrillator study details concerns

By Stephanie Nano
Associated Press / September 4, 2008
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NEW YORK - A lifesaving shock from an implanted heart defibrillator provides relief that a crisis was avoided, but new research suggests it can also be a sign that more trouble is ahead.

A study found that heart failure patients were far more likely to die within four years after their defibrillator zapped the heart into beating normally than those who got no shock.

Experts said patients should promptly tell their doctors if their defibrillator goes off. And doctors should check to see if their patients' condition has worsened and whether tests or medication changes are needed.

"We need to think about everything else we possibly could do to make them as healthy as they can be," said the study's lead author, Dr. Jeanne Poole of the University of Washington.

The findings are in today's New England Journal of Medicine, along with another study that concluded that having an implanted defibrillator doesn't appear to diminish one's quality of life.

About 234,800 North Americans have defibrillators, which cost between $25,000 and $35,000. The devices, about the size of a stopwatch, are designed to correct dangerously high or erratic heartbeats in the lower, pumping chambers of the heart.

Previous research found that the devices cut the risk of death by 23 percent.

The government-funded reports show a defibrillator prolongs "survival in patients with heart failure, with relatively little compromise in the quality of life," wrote Drs. Jeff Healey and Stuart Connolly of McMaster University in Ontario, in a journal editorial. But they added: "It is somewhat disturbing to realize that actually receiving a shock is such an important predictor of death."

In the study, about a third of the 811 patients with defibrillators were shocked during nearly four years of follow-up. Data recorded by the devices shows whether the shock corrected a life-threatening irregularity or was inappropriately fired by another problem, such as an abnormal rhythm in the heart's upper chambers.

The researchers found that those who needed a shock were more than five times more likely to die over the next four years than those who didn't require one. Even people who didn't seem to need a shock but got one had double the risk of dying.

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