Defibrillators Outdo Drugs in Test
(story from AP by Jeff Donn—December 15, 1999)
Implantable defibrillators, which shock a quivering heart back
into a regular rhythm, strongly outperformed drugs in fending off
cardiac arrest in a study of more than 700 patients.
"I don't think today we can rely on drugs to reduce the risk
of sudden death,'' said Dr. Alfred Buxton of Brown University and
Rhode Island Hospital, who led the study, published in the New England
Journal of Medicine. Researchers said the study is bound to expand
use of defibrillators, a 20-year-old device now implanted in roughly
100,000 patients.
About the size of a beeper, they are inserted under the skin in
the shoulder and connected by leads to the heart, restoring its
normal beat in episodes of potential cardiac arrest. A pacemaker,
by contrast, delivers a regular impulse to promote normal contraction
of the heart muscle. The implantable defibrillators work much the
same way as the larger emergency-room defibrillators that are a
staple of TV medical dramas.
The study involved 704 patients at 85 U.S. and Canadian hospitals.
They were already suffering from coronary artery disease, irregular
heartbeats and weakly pumping hearts. Defibrillators reduced the
five-year risk of cardiac arrest by 76 percent over drugs.
"We don't see many therapies in cardiovascular disease or
in other diseases that produce that large a benefit,'' said Kerry
Lee, a Duke University biostatistician who took part in the research.
More than 1 million patients have heart problems similar to those
in the study.
"The number of patients this applies to is enormous,'' said
Dr. Hugh Calkins, who specializes in heart rhythm problems at the
Johns Hopkins University. However, defibrillators ordinarily cost
about $20,000. Doctors said more work is needed to determine who
would gain the most benefit. The implantation procedure itself is
considered safe and simple and can often be done on an outpatient
basis.
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