Abstract 12621: Gender Differences Among Implantable Cardioverter Defibrillators Recipients in the Setting of Primary Prevention

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Eloi Marijon ◽  
Rui Providencia ◽  
Pascal Defaye ◽  
Didier Klug ◽  
Daniel Gras ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Dilated Cardiomyopathy ◽  
Specific Interaction ◽  
Severe Heart Failure ◽  
Real Life ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Cardioverter Defibrillators

Background: Data regarding sex specificities in the use, benefits and complications of implantable cardioverter-defibrillators (ICDs) in primary prevention in the real-world European setting are sparse. Methods: Using a large multicentric cohort of consecutive patients referred for ICD implantation for primary prevention (2002-2012), in the setting of coronary artery disease or dilated cardiomyopathy, we examined potential sex differences in subjects’ characteristics and outcomes. Results: Of 5,539 patients, only 837 (15.1%) were women and 53.8% received cardiac resynchronization therapy (CRT-D). Compared to men, women presented a significantly higher proportion of dilated cardiomyopathy (60.2% vs. 36.2%, P120ms: 74.6% vs. 68.5%, P=0.003), higher New York Heart Association functional class (2.5±0.7 vs. 2.4±0.7, P=0.003) and lower prevalence of atrial fibrillation (18.7% vs. 24.9%, P<0.001). During a 16,786 patient-years follow-up, overall, fewer appropriate therapies were observed in women (HR = 0.59, CI95% 0.45-0.76; P<0.001). By contrast, no sex-specific interaction was observed for inappropriate shocks (OR for women = 1.00, 95%CI 0.74-1.35, P=0.997) and mortality (HR = 0.87; 95%CI 0.66-1.15, P=0.324), with similar patterns of cause of deaths. Conclusion: In our real life registry, women account for the minority of ICD recipients. While female ICD recipients present with features of more severe heart failure in the setting of primary prevention of sudden cardiac death, we observed they have a 40% lower incidence of appropriate therapies.

P1658Pharmacological treatment of patients with HFrEF: is it really optimized in case of CRT and/or ICD implantation?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Logeart ◽  
R Isnard ◽  
T Damy ◽  
M Salvat ◽  
J C Eicher ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Pharmacological Treatment ◽  
Beta Blockers ◽  
Real Life ◽  
Cardiac Resynchronization ◽  
Icd Implantation ◽  
Reduced Ejection Fraction ◽  
Number Of Patients ◽  
Multicenter Survey ◽  
Mineralocorticoid Antagonists

Abstract Background Cardiac resynchronization (CRT) as well as implantable cardiac defibrillator (ICD) in primary prevention should be considered in patients with heart failure and reduced ejection fraction (HFrEF) only when pharmacological treatment has been optimized. Purpose we sought to analyze pharmacological treatments according to the presence or not of CRT-P, CRT-D or ICD in real life HFrEF patients by using a multicenter survey. Methods the survey (NCT01956539) was carried out between 2015 and 2018 in 32 hospitals and included 2735 patients with HF who gave their consent during consultation or hospitalization. In this study, we analyzed only outpatients with chronic HFrEF treated for more than 6 months. Results among 1061 patients studied, 138 had CRT-P or CRT-D and 215 had ICD for primary prevention. The main clinical characteristics were: age 65±13 years, ischemic heart disease in, NYHA classes 1, 2, 3 and 4 in 15%, 52%, 23% and 10% cases respectively, systolic blood pressure 115mmHg [IQR 104–129], heart rate 70bpm [IQR 60–80], eGFR 64ml/min/1.73m2 [IQR 46–83]and LVEF was 30% [IQR 24–34]. The table shows the rate of use of evidence-based drugs and the dose for ACEi/ARB and betablockers, according to the presence of ICD or CRT. HFrEF CRT-P or D ICD (primary prevention) n=1061 n=138 n=215 Loop diuretics 78.2% 79.7% 74.9% ACEi or ARB 65.2% 75.4% 67.3% Sacubitril/valsartan 5.9% 8.5% 9.5% Betablockers 72.3% 83.9% 76.8% Mineralocorticoid antagonists 45.7% 63.6% 60.2% ACEi/ARB mean % maxi dose 77 81 83 Beta-blockers mean % maxi dose 74 63 79 Conclusion these results suggest that pharmacological treatment remains poorly optimized in a number of patients with HFrEF who received ICD or CRT

scholarly journals Clinical effectiveness of primary prevention implantable cardioverter-defibrillators: results of the EU-CERT-ICD controlled multicentre cohort study

2020 ◽  
Vol 41 (36) ◽  
pp. 3437-3447 ◽  
Author(s):  
Markus Zabel ◽  
Rik Willems ◽  
Andrzej Lubinski ◽  
Axel Bauer ◽  
Josep Brugada ◽  
...  
Keyword(s):  
Cohort Study ◽  
Primary Prevention ◽  
Clinical Effectiveness ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Chronic Obstructive ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillators

Abstract Aims The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter-Defibrillators (EU-CERT-ICD), a prospective investigator-initiated, controlled cohort study, was conducted in 44 centres and 15 European countries. It aimed to assess current clinical effectiveness of primary prevention ICD therapy. Methods and results We recruited 2327 patients with ischaemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM) and guideline indications for prophylactic ICD implantation. Primary endpoint was all-cause mortality. Clinical characteristics, medications, resting, and 12-lead Holter electrocardiograms (ECGs) were documented at enrolment baseline. Baseline and follow-up (FU) data from 2247 patients were analysable, 1516 patients before first ICD implantation (ICD group) and 731 patients without ICD serving as controls. Multivariable models and propensity scoring for adjustment were used to compare the two groups for mortality. During mean FU of 2.4 ± 1.1 years, 342 deaths occurred (6.3%/years annualized mortality, 5.6%/years in the ICD group vs. 9.2%/years in controls), favouring ICD treatment [unadjusted hazard ratio (HR) 0.682, 95% confidence interval (CI) 0.537–0.865, P = 0.0016]. Multivariable mortality predictors included age, left ventricular ejection fraction (LVEF), New York Heart Association class &lt;III, and chronic obstructive pulmonary disease. Adjusted mortality associated with ICD vs. control was 27% lower (HR 0.731, 95% CI 0.569–0.938, P = 0.0140). Subgroup analyses indicated no ICD benefit in diabetics (adjusted HR = 0.945, P = 0.7797, P for interaction = 0.0887) or those aged ≥75 years (adjusted HR 1.063, P = 0.8206, P for interaction = 0.0902). Conclusion In contemporary ICM/DCM patients (LVEF ≤35%, narrow QRS), primary prophylactic ICD treatment was associated with a 27% lower mortality after adjustment. There appear to be patients with less survival advantage, such as older patients or diabetics.

The role of implantable cardioverter-defibrillators and sudden cardiac death prevention: indications, device selection, and outcome

2019 ◽  
Vol 41 (21) ◽  
pp. 2003-2011 ◽  
Author(s):  
Ilan Goldenberg ◽  
David T Huang ◽  
Jens Cosedis Nielsen
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Current Knowledge ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Device Selection ◽  
Cardioverter Defibrillators

Abstract Multiple randomized multicentre clinical trials have established the role of the implantable cardioverter-defibrillator (ICD) as the mainstay in the treatment of ventricular tachyarrhythmias and sudden cardiac death (SCD) prevention. These trials have focused mainly on heart failure patients with advanced left ventricular dysfunction and were mostly conducted two decades ago, whereas a more recent trial has provided conflicting results. Therefore, much remains to be determined on how best to balance the identification of patients at high risk of SCD together with who would benefit most from ICD implantation in a contemporary setting. Implantable cardioverter-defibrillators have also evolved from the simple, defibrillation-only devices implanted surgically to more advanced technologies of multi-chamber devices, with physiologic bradycardic pacing, including cardiac resynchronization therapy, atrial and ventricular therapeutic pacing algorithms, and subcutaneous ICDs. These multiple options necessitate individualized approach to device selection and programming. This review will focus on the current knowledge on selection of patients for ICD treatment, device selection and programming, and future directions of implantable device therapy for SCD prevention.

Abstract 4128: Evaluating Sex Differences in Population-Based Utilization of Implantable Cardioverter Defibrillators (ICDs): The Role of Cardiac Conditions and Non-Cardiac Comorbidities

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Derek R MacFadden ◽  
Jack V Tu ◽  
Alice Chong ◽  
Peter C Austin ◽  
Douglas S Lee
Keyword(s):  
Cardiac Arrest ◽  
Sex Differences ◽  
Primary Prevention ◽  
Cox Regression ◽  
Population Based ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Cardioverter Defibrillators ◽  
Information Database

BACKGROUND: Although sex differences exist in the use of ICDs, reasons for the disparities are poorly understood. We determined if age, comorbid conditions, or ICD indication explained the sex differences. METHODS: We examined all patients in Ontario, Canada, with cardiac arrest (CA, 1998 –2007), myocardial infarction (MI, 2002–2007), or heart failure (HF, 2005–2007), using the Canadian Institute for Health Information Database. MI and HF cohorts excluded those with prior CA, and included patients post-MADIT-2 and SCD-HeFT trials. Patients were followed until ICD implant using Cox regression, with hazard ratio (HR) >1.0 indicating greater likelihood of ICD implant in men. RESULTS: Among 9246 patients eligible for ICD implantation after CA, 237 (2.6%) women and 725 (7.8%) men received ICDs. In 105,516 primary prevention MI patients, 172 (0.2%) women and 836 (0.8%) men received ICDs. Among 61,160 primary prevention HF patients, 221 (0.4%) women and 852 (1.4%) men received ICDs. The rate of ICD implant was significantly higher in men across indications adjusting for age, prior arrhythmia, and comorbidities (Figure ). Post-CA, the HR for secondary prevention ICD was 1.92 (95%CI, 1.66 –2.23). Men were more likely to undergo ICD implant than women for primary prevention, with HRs 3.00 (95%CI, 2.53–3.55) post-MI and 3.01 (95%CI, 2.59 –3.50) in HF patients. Although death after primary prevention ICD did not differ by sex, mortality risk was higher in men after CA (HR 1.42; 95%CI, 1.03–1.95). CONCLUSIONS: Differences in ICD use for all indications were not explained by age or comorbidities. Despite increased use, men had reduced post-implant survival after cardiac arrest.

Abstract 317: Outcomes after Primary Prevention Implantable Cardioverter Defibrillator Placement: Results of the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter Defibrillators

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Frederick A Masoudi ◽  
Alan S Go ◽  
David J Magid ◽  
Liza M Reifler ◽  
Karen A Glenn ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Prevention ◽  
Left Ventricular ◽  
Research Network ◽  
Implantable Cardioverter Defibrillators ◽  
Heart Failure Hospitalization ◽  
Icd Implantation ◽  
Cardiovascular Research ◽  
Clinical Variables ◽  
Cardioverter Defibrillators

Background: Implantable cardioverter defibrillators (ICDs) are commonly used for the primary prevention of sudden cardiac death. Controversies persist, however, about outcomes in representative cohorts and in clinically important patient subgroups. Observational studies of outcomes following primary prevention ICD implantation are typically limited to relatively restricted cohorts (e.g. Medicare) or with short follow up. Methods: In the Cardiovascular Research Network (CVRN), we conducted a study in 7 integrated health care delivery systems to identify patients undergoing primary prevention ICD implantation for left ventricular systolic dysfunction between 2006-2010. Baseline procedural and clinical data were obtained from the NCDR ICD Registry; longitudinal data to ascertain outcomes after implantation were obtained through clinical health system data from the CVRN Virtual Data Warehouse. We assessed the occurrence of complications at 90 days and mortality, all-cause hospitalization, and heart failure hospitalization up to 5 years after implantation in clinical strata designated a priori. Multivariable models accounting for clustering of patients within site were used to assess the relationship between clinical variables and each outcome. Clinical variables of interest (Table) were included in all models; additional variables were assessed with forward selection to account for possible confounders. Results: Among 2953 eligible patients, median age was 69 years and 26% were women Coexisting conditions, including hypertension (74%), atrial fibrillation (32%), COPD (20%), and diabetes (42%), were common. Overall event rates (per 1000 patient years) were 110 for death, 438 for any hospitalization, and 58 for heart failure hospitalization. The association between clinically important variables and outcomes are shown in the Table. Conclusions: In a diverse population of patients undergoing ICD implantation in contemporary practice we identified specific clinical variables associated with adverse outcomes. These data can inform prognosis in clinical care and guide the design of future trials of this therapy.

scholarly journals Comparison of the benefit of primary prevention implantable cardioverter-defibrillator therapy in ischemic versus nonischemic dilated cardiomyopathy

2020 ◽  
Author(s):  
Kun Wang ◽  
Xinyue Xu ◽  
Yu Qi ◽  
Yihai Liu ◽  
Lina Kang ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Dilated Cardiomyopathy ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiovascular Death ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Icd Implantation ◽  
Pump Failure ◽  
Cardioverter Defibrillator ◽  
All Cause Mortality

Introduction: Ischemic cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy (DCM) share common structural alterations with a high mortality from sudden cardiac death (SCD) and pump failure. Implantable cardioverter-defibrillator (ICD) has, since inclusion in international guidelines, been confirmed beneficial and cost-effective for primary prevention of SCD in patients with ICM, while huge debates in non-ischemic heart disease. This study was to compare the primary prophylactic value of ICD therapy in patients with ICM or DCM to identify a subgroup with greater advantage specially. Methods: We conducted a retrospective, single-center study, which enrolled 82 patients with ICM or DCM and guideline indications for primary prophylactic ICD or cardiac resynchronization therapy-defibrillator (CRT-D). Primary end-point was all-cause mortality and secondary outcomes included SCD and cardiovascular death. Results: During a median follow-up of 38.5 months, 78 patients baseline data were analyzable. The primary outcome occurred in 8 patients in ICM group and 5 patients in DCM group (p = 0.012). Cardiovascular death occurred in 5 patients in ICM group and 3 patients in DCM group [hazard ratio (HR) 0.119, 95% confidence interval (CI) 0.016-0.860, P = 0.035]. Resuscitated cardiac arrest or sustained ventricular tachycardia occurred in 4 patients in ICM group and 8 patients in DCM group (HR 0.294, 95% CI 0.040-2.144, P = 0.227). Conclusions: DCM patients with ICD implantation could gain more benefit with a reduction in the risk of all-cause mortality and cardiovascular disease compared with ICM patients, while the occurrence of SCD had no difference in two groups.

scholarly journals Implantable Cardioverter-Defibrillator Placement for Primary Prevention in 2,346 Patients: Predictors of One-Year Survival

2018 ◽  
Vol 45 (4) ◽  
pp. 221-225 ◽  
Author(s):  
Faisal M. Merchant ◽  
Yaanik Desai ◽  
Maher A. Addish ◽  
Kimberly Kelly ◽  
Mary Casey ◽  
...  
Keyword(s):  
New York ◽  
Primary Prevention ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Heart Association ◽  
Functional Class ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Social Security Death Index ◽  
One Year

Guidelines suggest that patients who receive implantable cardioverter-defibrillators (ICDs) for primary prevention should be expected to live more than one year after placement. However, tools for validating this prognosis are not sufficiently predictive. We sought to identify definitive predictors of one-year survival after ICD placement. By reviewing medical records and the Social Security Death Index, we analyzed baseline characteristics and survival outcomes of 3,164 patients who underwent ICD placement at our institution from January 2006 through March 2014. Survival outcome could be confirmed for 2,346 patients (74%). Of these, 184 (7.8%) died within one year of ICD placement. We noted significant differences in numerous variables between those who lived and died. However, multivariable analysis revealed only 5 independent predictors of earlier death: worse New York Heart Association functional class (hazard ratio [HR]=1.87 per class [95% CI, 1.22–2.87]; P &lt;0.01); lower serum sodium level (HR=0.93 per 1 mEq/L increase [95% CI, 0.88–0.99]; P=0.04); atrial fibrillation (HR=1.81 [95% CI, 1.03–3.21]; P=0.04); chronic lung disease (HR=2.05 [95% CI, 1.20–3.51]; P &lt;0.01), and amiodarone use (HR=10.1 [95% CI, 4.51–22.5]; P &lt;0.01). Using receiver operating characteristic curves, we developed a model with an area under the curve of 0.718 that predicted death at one year after ICD implantation. Despite significant univariate differences between the ICD recipients who did and did not live beyond one year, we found only moderate predictors of survival. Better tools are needed to predict outcomes when considering ICD placement for primary prevention.

Sign in / Sign up

Export Citation Format

Share Document