Hold that beat, vest defibrillator comes to rescue of heart patients

Can be used while waiting for new organ

Larry and Sally Wagner credit the defibrillator vest with saving his life in October, after it detected his heart had stopped beating. Enlarge photo

Robert D. Tonsing/Colorado Public News

Larry and Sally Wagner credit the defibrillator vest with saving his life in October, after it detected his heart had stopped beating.

For thousands of Coloradans at serious risk for a sudden heart attack, some doctors and patients say a high-tech vest that literally jump-starts the heart can be the difference between life and death.

The brand name “LifeVest” is a battery-operated defibrillator that heart patients wear under their clothes all day. The device was federally approved a decade ago, but is increasingly being prescribed by doctors for at-risk heart patients and those waiting for surgery.

“A year ago, I wasn’t using them. I was very skeptical,” said Dr. Sri Sundaram, a cardiac electrophysiologist with South Denver Cardiology Associates. Sundaram has prescribed the vest to three patients so far. “I’m not a firm believer yet, but I’m getting there. The data says it works.”

Company officials say doctors are currently prescribing the vests at a rate of 25 a month in Colorado. Nationally, 50,000 patients have used them since 2002.

A recent study of more than 3,500 patients done by the Cleveland Clinic found that the vest was as effective in saving lives as a surgically implanted defibrillator. It is different from the implant, though, in that it does not require a second person to apply electrodes. The device straps across the chest and continually monitors an ailing heart. If the heart stops or beats irregularly, sensors immediately send the heart a shock to get it back to its normal rhythm.

Sudden cardiac arrest is the leading cause of death in Americans, killing 330,000 people every year. More people in the U.S. die from it than colorectal cancer, breast cancer, prostate cancer, auto accidents, AIDS, firearms and house fires combined.

The defibrillator vest is not meant to be worn forever. It’s a temporary fix for patients who must get a clean bill of health before they receive an implanted defibrillator. Doctors say the three-to-nine-month wait for permanent defibrillators can be a time fraught with anxiety for patients, because at any time during that period, the heart could give out.

“Either you get better during that bridge period or you die,” said Sundaram. “Most get better.”

In fact, 30 to 40 percent of those with cardiac problems find out they don’t need a defibrillator at all, saving unnecessary surgery and thousands of dollars in health-care costs. However, statistics show that 8 percent of patients do not survive.

For others, though, the vest “is a reassurance during that critical window period,” said Dr. Arnold Pfahnl, a cardiac electrophysiologist at Greeley Medical Center whose specialty is the electrical system of the heart.

“The upside to the vest is that it saves lives,” Pfahnl said. “The downside is the vest has been known to shock inappropriately, which is rare.”

Also, vest rental can be expensive, at about $3,000 a month. Medicare will cover the cost, with a doctor’s approval.

Larry Wagner, who lives with his wife at their son’s house in the rural Colorado town of Nunn, credits the vest for saving his life this last fall.

“Just when was it that I died, Sally?” the 73-year-old Wagner said his wife during a recent interview. “October 7th,” she replied.

Sally Wagner remembers that day well. She caught her husband just as he was falling into a screen door. Despite frantic mouth-to-mouth resuscitation efforts, her husband was lifeless for a minute and three seconds.

Neither of the Wagners realized it then, but the vest Larry Wagner was wearing had detected that his heart had stopped, and shocked him back to life. He says he didn’t feel the shock when it happened.

“Me dying wasn’t like the stories you hear about where a light is shining from far away,” he said. “It was more like a shutter went down, and then it went up.”

He still has the T-shirt the EMTs ripped off his body. It’s stained with a yellow-green dye, from a gel the vest released when it kicks in. The dye is a signal for medical personnel to inform them that there’s been an electrical shock.

The vest has chest and shoulder straps, and therapy pads that press close to the skin in the front and back. A heart monitor about as big as a paperback book can be hooked to a belt. It will get smaller, doctors say, eventually shrinking to the size of a patch.

One of the earlier problems with the vest is that people weren’t wearing it as often as they should, complaining of discomfort. It’s up to the patient to keep it on.

Wagner says he removed his vest once a day to shower, and that “getting the pads in place was a real pain.”

It was worth it. Dr. Phahnl says when his patient was brought to the emergency room, doctors there could not get him to take it off.

“It saved my life,” Wagner said.

Colorado Public News, a nonprofit news organization, reports on issues of statewide interest. It partners with Colorado Public Television 12, Denver’s independent PBS station.