Doctors are implanting high-tech heart devices in thousands of people who probably do not need them, a new study finds. The procedures cost more than $35,000, involve surgery and anesthesia, and may unnecessarily harm some patients.
The devices, called defibrillators, fire an electrical shock to jolt the heart back into a normal rhythm if it starts to beat in a disordered way that can cause sudden death. In people who truly need them, for conditions that can fatally disrupt heart rhythm, defibrillators can be life-saving.
Each year, about 100,000 are implanted in the United States. The new findings fit into a larger pattern of misuse of defibrillators: Paradoxically, previous research has also found that many people who need defibrillators do not get them. The reasons are not known but may include the cost and also a reluctance by both doctors and patients to accept a surgically implanted device, especially if the patient is feeling fine and has no symptoms of the underlying problem.
Professional societies set guidelines that specify when the defibrillators should be used, based on studies showing which patients they help. To find out if doctors have been complying, researchers examined the records of 111,707 people who received the implants at 1,227 U.S. hospitals from January 2006 to June 2009. The records were part of a national registry, and the National Heart, Lung and Blood Institute paid for the study.
The researchers were surprised to find that more than 25,000 people — 22.5 percent of all those who got defibrillators — did not match the guidelines. Most of the patients were 64 to 68. For unknown reasons, blacks and Hispanics were more likely than whites to get defibrillators they probably did not need. At many centers, more than 40 percent of the devices went to patients outside the guidelines.
Why are doctors not following the expert advice? Apart from the reasonable judgment calls, Dr. Sana M. Al-Khatib, an associate professor of medicine at Duke University and the lead author of the study, said she thought many doctors did not know the guidelines or understand the evidence behind them, and thought they were helping patients by putting in the devices to save them just in case their heart rhythms went awry.
Even so, 37 percent of the devices implanted outside the guidelines went to people who had had heart attacks in the previous 40 days.
Some of those patients will eventually need defibrillators anyway, but 30 percent to 40 percent will not, said Dr. Alan Kadish, a cardiologist who is president of Touro College.
Kadish said he thought it possible but unlikely that some doctors were implanting devices unnecessarily to make money.
Both Khatib and Kadish said the solution was better education for doctors. Neither wanted hospital panels, insurance companies or the government to be given the power to decide who should receive a defibrillator.