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Wait-And-See Policy On Heart Devices Puts Lives At Risk, Says UK Charity

Patients are needlessly being put at risk of dying from heart problems because they have to wait months to be fitted with lifesaving implantable defibrillators, experts have said.

Two million people in the UK live with coronary heart disease, which is a leading cause of heart failure. Those at the highest risk of dying as a result of heart failure may be offered an implantable cardioverter defibrillator device (ICD). These can kickstart the heart and may save their life.

Patients have to wait at least 90 days before they can be fitted with an ICD while doctors wait to see if stents and medication might improve their health. However, a large study funded by the British Heart Foundation suggests there is little or no benefit to waiting, and the charity says lives are needlessly being put at risk as a result.

Dr Sonya Babu-Narayan, an associate medical director at the BHF, said the results had significant implications.

“The findings suggest that the current ‘wait and see’ approach to find out whether a patient’s heart function improves with medication and stents isn’t always best, and that an unnecessary wait could even be the difference between life and death,” she said.

“The results from this large UK-wide trial could lead to re-evaluation of how best to treat people living with severe heart failure due to coronary heart disease.”

The team behind the research, led by Prof Divaka Perera at King’s College London, believe it may lead to changes in heart failure guidelines worldwide. ICDs should be given to the highest-risk heart failure patients earlier, the research suggests.

ICDs are placed under the skin, usually just below the collar bone. Thin wires connect them to the heart and they monitor its rate and rhythm.

If an ICD notices a dangerous heart rhythm, it can deliver a series of low-voltage electrical impulses at a fast rate to try to correct it, small electric shocks to try to restore the heart to a normal rhythm, or larger electric shocks.

For patients with severe heart failure, doctors may insert stents to open any blocked arteries. Before ICDs can be considered, patients must wait at least 90 days to see if stents or medication improve the pumping action of the heart.

Researchers recruited 700 patients from 40 hospitals in the UK who had coronary heart disease and severely weakened function of the left ventricle. Half were randomly assigned to have stents. Everyone was followed for up to eight years.

The study found stents did not reliably improve the heart’s ability to pump, nor did they reduce the risk of life-threatening heart rhythm disturbances or the number of cardiac arrests and deaths. As a result, patients at risk should not have to wait before they are fitted with lifesaving ICDs, the researchers said.

While stents were shown not to improve heart function in patients with severe heart failure, the team stressed that they remained an effective treatment for heart attack patients or people with angina.

Dr Holly Morgan, a BHF clinical research fellow who was involved in the research, said: “Our findings have revealed that many patients with high risk of heart failure could benefit from receiving an ICD straight away, rather than facing a 90-day wait.

“By showing that coronary stents had limited benefit for this group of heart patients, we have exposed a clear window of missed opportunity to reduce chances of dying from an abnormal heart rhythm. We hope our findings will influence existing guidance so patients can be spared unnecessary waits to receive a potentially lifesaving defibrillator.”

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