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Unwanted shocks
Implantable cardioverter-defibrillators (ICDs) have been shown to reduce the number of deaths from ventricular fibrillation and ventricular tachycardia. However, inappropriate discharges from implantable cardioverter-defibrillators (ICDs) are associated with a number of adverse physical and psychological symptoms. Two recent studies (MADIT-RIT and ADVANCE III) have suggested that increasing the threshold for delivering shocks, based on traditional triggers such as ventricular rate and duration of arrhythmias, reduces the number of inappropriate shocks. The evidence suggests that this is associated with a reduction in overall mortality by approximately 50%, at the expense of a small risk of pre shock syncope (JAMA 2013;309:1937–8).
Think strong—live longer
A thought provoking article published in Age and Ageing (2012;41:789–94) suggests that an older person's ‘will to live’ can predict their chance of surviving a further 10 years. Surveying Finnish patients enrolled in a cardiovascular prevention trial, those aged 75–90 years were asked ‘How many years would you still wish to live?’ After 10 years of follow-up, the authors conclude that ‘will to live’ is a strong …