New Guidelines Issued for Implanted Heart Devices

THURSDAY May 15, 2008 -- New guidelines for implanted heart devices such as pacemakers and defibrillators emphasize that they're just one aspect of cardiac care.

"This is a very specific statement of the importance of optimized medical care," Dr. Andrew Epstein, professor of medicine at the University of Alabama at Birmingham's Division of Cardiovascular Disease, said as he introduced the guidelines Thursday at the Heart Rhythm Society annual meeting, in San Francisco.

The guidelines "will be of tremendous importance not only to cardiologists, but also all physicians as well as the community at large," added Dr. Richard Page, head of the division of cardiology at the University of Washington School of Medicine and program chair of the meeting.

An estimated 180,000 pacemakers and 91,000 defibrillators were implanted in Americans in 2005. Pacemakers keep hearts beating regularly; defibrillators deliver an electric shock to restart an arrested heart or help an irregularly beating heart to return to normal.

The new guidelines update those published in 2002 on implanted cardiac devices. "They are as evidence-based as can possibly be," using information gathered in scores of controlled trials, Epstein said.

The committee drawing up the guidelines included members from the American College of Cardiology, the American Heart Association and the Heart Rhythm Society. The guidelines were expected to be published in the journals and posted on the Web sites of all three organizations.

One important aspect of the new guidelines is that it points out the value of implanted devices in preventing serious coronary problems, rather than being used after such problems occur, Epstein said.

Another important change is that "we have expanded the section on heart failure greatly," Epstein said. Heart failure, which is the progressive loss of the ability to pump blood, is a major contributor to cardiac mortality. An implanted device should be used only if symptoms persist when someone with heart failure already is receiving optimum drug therapy, with medications such as ACE inhibitors and beta blockers, the committee wrote.

The new guidelines also note the importance of talking about the risks and benefits of implanted devices with the patient and family. "We've always tried to do that, and it is formally articulated in the guidelines," Epstein said.

The emphasis on considering implanted devices as one part of an overall strategy arises partly from the greatly expanded used of cardiac medications. For example, more than 80 percent of Americans with coronary disease now get beta blockers, he said.

"We emphasize that the global approach to patients saves lives," Epstein said.

More information

Learn more about heart devices from the U.S. Food and Drug Administration.

Posted: May 2008


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