January 6, 2011

Cardiologists May Be Implanting Defibrillators Too Soon

Posted in Heart Disease in the News, Uncategorized tagged , , , , , , , at 11:22 am by keepyourhearthealthy

LifeVest

LifeVests can be given instead of ICD when patients do not meet criteria

The National Cardiovascular Data Registry has released new data suggesting that cardiologists are jumping the gun with ICD’s (Implantable Cardioverter Defibrillators).

Initially, the data seems quite shocking: nearly a quarter of ICD’s were put in despite not meeting the criteria between 2006 and 2009.  The report also goes on to say that the people who received unnecessary ICD’s had more in-hospital complications.  Apparently one of the most popular reasons why these ICD’s did not fall into the guidelines was because the cardiologist did not wait long enough.  The guidelines dictate that you should wait 3 months after a diagnosis of heart failure and at least 40 days after a heart attack before placing an ICD inside someone’s chest. For the most part, the patients who received the ICD’s outside of the guidelines were very sick patients who had a low heart function and were at high risk of deadly heart rhythms.    It seems certain that the cardiologists who implanted the ICD’s had a higher suspicion of poor outcome for these patients and were trying to prevent it.  The fact that those patients were shown to have more complications in the hospital means that the cardiologists were right to suspect a worse prognosis.

As you might expect, this report has started some heated controversy among the clinicians who regularly implant ICD’s.  Comments in response to the article on theheart.org range anywhere from talks of indictment to the blame game to roadblocks for appropriate treatment in the future.  Some clinicians are saying these “inappropriate” ICD’s are more often being put in by cardiologists who do not specialize in putting in devices and are therefore unfamiliar with the guidelines.  Many other clinicians are defending the implants and pointing out the need for treating each patient individually instead of practicing “cookbook medicine.”

A few clinicians have already stepped forward to provide a  solution to the problem of early implants…a LifeVest.  Not the water kind that saves you from drowning but the defibrillator kind that saves you from deadly heart rhythms.  A LifeVest is a wearable defibrillator that can go home with you from the hospital.  As long as you are wearing the vest then you are protected.  This can help get people through the recommended timeline of 40 days after a heart attack or 3 months after a diagnosis of heart failure.  At the end of that timeline a patient may not even require an ICD if their heart has recovered well enough.  Read more about a personal story on the LifeVest at:

Close to the heart | The Times Leader, Wilkes-Barre, PA.

January 2, 2011

Is Your Defibrillator Beeping?

Posted in Heart disease tips, Uncategorized tagged , , , , , , , , , at 8:44 pm by keepyourhearthealthy

photo by Jeroen van Oostrom

At first you may not realize that the beep is coming from inside your body but eventually you find that the metal box inside your chest is making a strange sound.

Patients who undergo implantation of a device such as a defibrillator may hear a beeping from their device at some point.  It may seem harmless in the beginning but soon enough panic can set in.  You start to wonder if the lifesaving box is broken and immediately look for your cardiologist’s office number.  You might even consider going to the Emergency Room if it’s late at night.

Laurie Racenet, an electrophysiology nurse practitioner and device expert, explains all you need to know in a situation like this:

“As a Nurse Practitioner in a Device Clinic, I hear all kinds of questions from patients about their devices.  One of the more common questions is: ‘Why is my device beeping?’

Devices beep for a number of reasons.   Currently Implantable Cardiac Defibrillators (ICDs) are the only device that will beep.  There are no pacemakers currently on the market that will beep for any reason. [Pacemaker and defibrillator combinations will also beep as long as it has a defibrillator component in the device.]

The most frequent cause of beeping is that the device is nearing the end of the battery. Depending on the device manufacturer, the device may have anywhere from 2 – 6 months of battery left when the beeping first sounds.  Most devices are designed to only beep for a short time each day; however, the sound can be annoying for patients who are sensitive to noise.  Sometimes the beep can be so soft that the patient doesn’t hear it at all.  This is particularly true for folks with hearing impairment.   It is not uncommon for a family member or friend to be the first to hear the beeping.  One manufacturer has tried to address this issue by making the device vibrate in the chest when the battery is getting low.

Another cause for the beeping is that there is a problem with one of the leads, or an internal problem with the device.   Modern devices are designed to do internal testing at various intervals.  If this internal testing shows some type of problem with a lead or some other problem, the device will beep to alert the patient that there may be a problem.  It is important to understand that the internal testing is not perfect and the device may beep when there is no problem.  It is designed to err on the side of safety and notify the patient if it thinks something is wrong.

Some devices may be programmed to beep when the patient has received therapy from the device. Since more and more devices are being set up to deliver painless therapy for abnormal heart rhythms, many people do not even know when they have received therapy from the device.  The device can be set up to beep if multiple therapies are delivered.

So what does all of this mean to the person who hears the device beeping?

  • Whenever beeping is heard, call your device clinic.   If you are being monitored by one of the many remote follow-up devices, you will be able to download the information from home for the device clinic to evaluate.  One of the best parts of the newest remote monitoring systems is that the device will send an alert to the clinic for any circumstance that would cause it to beep, thus adding an extra measure of safety to device monitoring.  Otherwise, the device clinic will have you come in and they will download the information in the clinic.
  • If you know your device is getting low on battery, you can usually wait and call during regular business hours, but it is never wrong to call and talk to whoever is on-call for the device clinic if you have any concerns about the device beeping.  Most of us would rather have a patient call so that we can assess the situation, rather than find out later that there was a problem.
  • If you have a newer device and have no reason to suspect that your battery is getting low, you should call the on call person for the device clinic whenever you hear a beeping.  During regular clinic hours, you can call the clinic directly.
  • If you have a lead that is known to be high risk for problems, call immediately whenever you hear a beep.  You may be asked to call 911 and go to the Emergency Room.  Your device clinic can let you know if you have one of these high risk leads.

To determine if you can hear the beep, ask your device clinic to demonstrate these tones to you at your next clinic visit.  Ask how your device is set up and what your device can or will beep for.  Some devices have different tones for different issues. Ask to have all the tones that are on your device demonstrated.  In addition, ask your clinic who you should contact when your device beeps.  Make sure you know what number to call after regular business hours to reach someone if you have concerns.

Having a device can be stressful for most people.  I hope this has helped to answer some questions.”