Costlier Heart Device May Not Be Worth It, Study Suggests

Dual-chamber implanted defibrillators had more complications than single-chamber models

By Brenda Goodman

HealthDay Reporter

TUESDAY, May 14 (HealthDay News) -- Patients prone to dangerously fast heart rhythms may get just as much help and have fewer complications with less-expensive implanted defibrillators that run one wire to the heart instead of two, a new study shows.

Implantable cardioverter defibrillators, or ICDs, are like having an emergency "crash cart" in the chest. The devices can sense runaway heart rhythms and deliver powerful shocks to jolt the heart back to a normal, steady pace.

Studies have shown that the devices cut deaths in patients at risk for sudden cardiac arrest because their heart muscles are too weak to effectively pump blood throughout the body, a condition called cardiomyopathy.

But little evidence exists to help doctors decide when it's better to choose a single-chambered ICD for patients or the more complex dual-chambered model.

The study, published in the May 15 issue of the Journal of the American Medical Association, compared the fates of more than 32,000 Medicare patients who received ICDs, from 2006 through 2009. None of the patients also needed a pacemaker, a device that speeds up a slow heartbeat.

"There is evidence for greater risk of complications. Not clear evidence of benefit. That risk-benefit ratio really doesn't support the routine use of dual-chamber devices for primary prevention," said study co-author Dr. Pamela Peterson, an associate professor of medicine at the University of Colorado at Denver.

About one-third of patients received a single-chamber ICD, in which an electrical lead is attached to the heart's lower right pumping chamber. The other two-thirds got dual-chamber devices, in which wires are attached to the upper and lower chambers of the heart's right side.

After a year, patients who got single-chamber ICDs were no more likely to die or be hospitalized than patients who got the more expensive dual-chamber models. They were, however, slightly less likely to face serious complications, including fluid build-up around the heart or lungs and mechanical problems with the device that required a second surgery to fix.

That was true even after researchers adjusted their results to control for any differences between patients who got single- and dual-chamber devices.

Overall, close to 4 percent of patients with single-chamber ICDs had complications with their devices compared to about 5 percent of patients with dual-chamber models, the investigators found.

The study was observational, which means researchers couldn't prove that the type of ICD was the only reason patients fared the way they did. Though they tried to carefully control their data for important differences between the two groups, other factors they couldn't measure, such as medications people were taking, may have influenced the results.

The study was funded by a grant from the U.S. Agency for Healthcare Research and Quality.

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Heart Device 'Shock' Anxiety May Hamper Sex Life

Study found more sexual dysfunction among men, women with implanted defibrillators

By Robert Preidt

HealthDay Reporter

FRIDAY, June 7 (HealthDay News) -- Anxiety-related sexual problems occur among young adults with congenital heart disease who have implanted heart defibrillators, a new study finds.

Their anxiety about the possibility of receiving a shock from their implantable cardioverter-defibrillator (ICD) can lead to sexual dysfunction, according to the study in the June issue of the journal HeartRhythm.

The researchers looked at 70 patients with an ICD and 110 patients without an ICD, average age 32, and found that those with ICDs had a high level of shock-related anxiety. Elevated anxiety was associated with poorer sexual function in both men and women.

This is the first study to reveal that shock-related anxiety is associated with sexual dysfunction in young adults with ICDs, according to the researchers. They said the findings point to the need to address these issues in order to improve the quality of life for these patients.

"ICDs are increasingly being implanted in this young and vulnerable patient population, yet the psychosocial issues are often overlooked. Our study is an example of dynamic research intended to help us better understand this growing population," lead author Dr. Stephen Cook said in a news release from the Heart Rhythm Society.

"Improving outcomes and the quality of life in these young adults is critical and our results clearly show the importance of addressing their psychological well-being," added Cook, who is with the Adult Congenital Heart Disease Center at the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center.

Congenital heart defects are among the most common types of birth defects, according to the news release. In 2000, the estimated number of U.S. adults with congenital heart disease was between 650,000 and 1.3 million, and the number rises each year. This means that a growing number of adults with congenital heart defects are receiving ICDs.

For patients with shock-related anxiety, early identification might lead to help such as education, treatment planning and referral to a mental health expert, the study authors said.

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Study Probes Use of Filter Device to Stop Deadly Blood Clots

Title: Study Probes Use of Filter Device to Stop Deadly Blood Clots
Category: Health News
Created: 3/18/2013 4:35:00 PM
Last Editorial Review: 3/19/2013 12:00:00 AM

View the original article here

Costlier Heart Device May Not Be Worth It, Study Suggests

Dual-chamber implanted defibrillators had more complications than single-chamber models

By Brenda Goodman

HealthDay Reporter

TUESDAY, May 14 (HealthDay News) -- Patients prone to dangerously fast heart rhythms may get just as much help and have fewer complications with less-expensive implanted defibrillators that run one wire to the heart instead of two, a new study shows.

Implantable cardioverter defibrillators, or ICDs, are like having an emergency "crash cart" in the chest. The devices can sense runaway heart rhythms and deliver powerful shocks to jolt the heart back to a normal, steady pace.

Studies have shown that the devices cut deaths in patients at risk for sudden cardiac arrest because their heart muscles are too weak to effectively pump blood throughout the body, a condition called cardiomyopathy.

But little evidence exists to help doctors decide when it's better to choose a single-chambered ICD for patients or the more complex dual-chambered model.

The study, published in the May 15 issue of the Journal of the American Medical Association, compared the fates of more than 32,000 Medicare patients who received ICDs, from 2006 through 2009. None of the patients also needed a pacemaker, a device that speeds up a slow heartbeat.

"There is evidence for greater risk of complications. Not clear evidence of benefit. That risk-benefit ratio really doesn't support the routine use of dual-chamber devices for primary prevention," said study co-author Dr. Pamela Peterson, an associate professor of medicine at the University of Colorado at Denver.

About one-third of patients received a single-chamber ICD, in which an electrical lead is attached to the heart's lower right pumping chamber. The other two-thirds got dual-chamber devices, in which wires are attached to the upper and lower chambers of the heart's right side.

After a year, patients who got single-chamber ICDs were no more likely to die or be hospitalized than patients who got the more expensive dual-chamber models. They were, however, slightly less likely to face serious complications, including fluid build-up around the heart or lungs and mechanical problems with the device that required a second surgery to fix.

That was true even after researchers adjusted their results to control for any differences between patients who got single- and dual-chamber devices.

Overall, close to 4 percent of patients with single-chamber ICDs had complications with their devices compared to about 5 percent of patients with dual-chamber models, the investigators found.

The study was observational, which means researchers couldn't prove that the type of ICD was the only reason patients fared the way they did. Though they tried to carefully control their data for important differences between the two groups, other factors they couldn't measure, such as medications people were taking, may have influenced the results.

The study was funded by a grant from the U.S. Agency for Healthcare Research and Quality.

View the original article here

Nerve-Stimulating Device Might Ease Migraines

By Alan Mozes

HealthDay Reporter

WEDNESDAY, Feb. 6 (HealthDay News) -- Migraine sufferers in search of a non-medicinal alternative for relief may be encouraged by new Belgian research that suggests that 20 minutes a day of nerve stimulation might cut back on the frequency of attacks.

The finding stems from a small study involving 67 migraine patients. All participants were outfitted with a wearable device called a "supraorbital transcutaneous stimulator," or STS, which was placed on the forehead and designed to deliver electrical stimulation to the patient's supraorbital nerve.

Use of the stimulator device was found to be "effective and safe as a preventive therapy for migraine," according to the study.

Study lead author Dr. Jean Schoenen, of the headache research unit in the department of neurology & GIGA-neurosciences at Liege University, and colleagues described the team's findings in the Feb. 6 online issue of Neurology.

Study participants were aged 18 to 65 and were being treated for migraines at one of five headache clinics in Belgium. All routinely experienced a minimum of two -- and an average of four -- migraine attacks per month. Although some had previously tried standard drug-based treatments, none had been taking any type of preventive chronic anti-migraine treatment in the three months leading up to the study launch.

Between 2009 and 2011, the patients were randomly divided into two groups. Both were given identical self-adhesive stimulation electrode pads to place on their forehead for 20 minutes daily over a three-month period. However, one group's electrode was a sham device that exerted an ineffectively weak electrical pulse, while the second group wore a working supraorbital transcutaneous stimulator.

Participants kept migraine diaries, which revealed that although migraine severity did not decrease much, by the third month of the study, those using the working devices saw the frequency of their attacks drop from about seven per month to fewer than five.

Sham device users experienced no such drop-off.

In addition, 38 percent of the working device users saw their attacks drop off by half or more, compared with 12 percent for those using fake stimulators.

Monthly use of anti-migraine drugs to cope with migraine attacks when they occurred dropped by nearly 37 percent among supraorbital transcutaneous stimulator users, with no drop among the sham group.

Schoenen and her associates said that the exact mechanism by which electrical stimulation seems to help migraine sufferers remains unclear, though they suggested it might have something to do with the neurological prompting of a "sedative effect."

Perhaps most important was the finding that none of the stimulator users experienced any side effects.

The researchers point to a previously conducted analysis of studies focusing on the impact of taking a 100-milligram dosage of topiramate -- a standard migraine drug. That analysis showed that the drug was considerably more effective than the nerve stimulator devices in its ability to reduce the frequency of monthly attacks.

View the original article here