1. Joy, Subhashni D. Singh

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According to this study:


* Implantable cardioverter-defibrillator therapy didn't adversely affect quality of life in patients with depressed left ventricular function.



In this prospective study of 2,521 patients with congestive heart failure and depressed left ventricular function (an ejection fraction of 35% or less), Mark and colleagues compared the quality of life of patients receiving three different treatments. Patients were randomized to receive state-of-the-art medical treatment plus amiodarone, treatment plus placebo, or treatment plus a single-chamber implantable cardioverter-defibrillator (ICD). Follow-up at 46 months showed 23% lower mortality in the ICD group compared with the placebo group; amiodarone didn't affect mortality.


ICDs increased survival, but the authors wanted to assess whether ICD patients had a quality of life comparable to that of the other patients at 30 months after treatment. Compared with the placebo group, the ICD and amiodarone groups had similar cardiac-specific physical functioning at baseline and at months 3, 12, and 30. Psychological well-being was similar in the ICD and placebo groups at baseline and at 30 months; the ICD group had significantly higher scores at 3 and 12 months. The amiodarone and placebo groups had similar scores throughout the study. The ICD group rated their overall health higher than the placebo group at 3 and 12 months, but the groups had similar scores at 30 months.


Several patients received ICD shocks during the study period, and their quality-of-life scores were lower than those of patients in the placebo group at one month and, to a lesser extent, at two months after the shock. This difference was not seen one year after the shock. The authors concluded that ICD therapy extended survival without adversely affecting quality of life.




Mark DB, et al. N Engl J Med 2008;359(10): 999-1008.