Abstract 16496: Longitudinal Outcomes After Implantation of a Subcutaneous or Transvenous Implantable Cardioverter Defibrillator in Older Patients: A Report From the National Cardiovascular Data Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniel J Friedman ◽  
Craig Parzynski ◽  
E. Kevin Heist ◽  
Andrea M Russo ◽  
Isuru Ranasinghe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Older Patients ◽  
Cox Regression ◽  
Ischemic Heart ◽  
Cardioverter Defibrillator ◽  
Data Registry ◽  
All Cause Mortality ◽  
National Cardiovascular

Introduction: The subcutaneous (S-) implantable cardioverter defibrillator (ICD) is an alternative to the transvenous (TV-) ICD that is increasingly implanted in younger patients. However, data on the safety and effectiveness of the S-ICD in older patients are lacking. Methods: We compared S-ICD and single chamber TV-ICD implants in Medicare beneficiaries (≥65yrs) using National Cardiovascular Data Registry ICD Registry data from 9/28/2012 through 12/31/2017. We excluded patients with prior pacemaker or ICD, an indication for pacing or resynchronization, and those undergoing implant in an acute setting. Mortality status was determined using the Medicare master summary beneficiary file. Cox regression analyses with overlap weights were used to compare all-cause mortality. Mean cumulative counts of all-cause readmissions were compared among for Fee for Service beneficiaries. Results: A total of 23,717 patients met inclusion criteria [mean age 72.7±5.8 years, 29% female, 69% ischemic heart disease, 33% atrial arrhythmias, 49% NYHA II, 31.7% NYHA III, ejection fraction (EF) 28±9%, 3% dialysis dependent, 20% with prior ventricular tachycardia]. Compared to TV-ICD patients (n=22,264), S-ICD patients (n=1,453, 6% overall) were more often male, black, diabetic, dialysis dependent and were less likely to have atrial or ventricular arrhythmias or ischemic heart disease. There was no difference in age or EF between the 2 groups. In adjusted analyses, during a median follow-up of 2.3 years (IQR: 1.2 - 3.5), there was no difference between the 2 groups in all-cause mortality (HR 1.04, CI 0.91-1.17, Figure A ) or readmissions (based on overlap of confidence intervals, Figure B ). Conclusions: In a large representative cohort of older patients undergoing ICD implant, all-cause mortality and readmission were similar among S-ICD and TV-ICD recipients. These findings support use of the S-ICD for the prevention of sudden cardiac death in appropriately selected older patients.

scholarly journals PREDICTION OF NON-BENEFIT FROM IMPLANTABLE CARDIOVERTER DEFIBRILLATOR TREATMENT IN PRIMARY PREVENTION PATIENTS WITH ISCHEMIC HEART DISEASE

2011 ◽  
Vol 57 (14) ◽  
pp. E140
Author(s):  
Johannes B. Van Rees ◽  
C. Jan Willem Borleffs ◽  
Guido H. van Welsenes ◽  
Enno T. van der Velde ◽  
Lieselot van Erven ◽  
...  
Keyword(s):  
Heart Disease ◽  
Primary Prevention ◽  
Ischemic Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Ischemic Heart ◽  
Cardioverter Defibrillator

scholarly journals Mortality, appropriate and inappropriate shocks - observations from an institutional implantable cardioverter defibrillator registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
I Prepolec ◽  
V Pasara ◽  
E Ciglenecki ◽  
JE Bogdanic ◽  
J Putric Posavec ◽  
...  
Keyword(s):  
Heart Disease ◽  
Secondary Prevention ◽  
Ischemic Heart Disease ◽  
Ischaemic Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Ischemic Heart ◽  
Cardioverter Defibrillator ◽  
Inappropriate Shocks ◽  
Device Infection

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Implantable cardioverter defibrillator (ICD) is an effective therapy for primary (PP) and secondary prevention (SP) of sudden cardiac death (SCD). ICD adverse events include inappropriate shocks (IS), device infection and failure.  Methods We analysed the data concerning all newly implanted ICDs in our institution from 2011 to 2017. Follow-up data was collected until the end of 2019. Results In total, 507 ICDs were implanted (85.4% male, 57.6 ± 14.0 years-old), 375 (74.0%) for PP and 132 (26.0%) for SP. The mean follow-up was 34.3 ± 23.8 months. ICD delivered therapy in 42.4% of SP and in 28.8% of PP patients (p = 0.15). In PP, shocks were delivered in 25.7% of non-ischaemic heart disease (NIHD) and in 17.6% ischaemic heart disease (IHD) patients (p = 0.81). IS were significantly more common in NIHD patients (13.8% vs 2.4% in IHD group, p < 0.0001). PP patients with NIHD also had a higher shock burden (average of 8.0 ± 17.4 shocks compared to 2.7 ± 3.0 in the IHD group). However, it failed to reach the level of statistical significance (p = 0.052). In SP, the rate of ICD activation and that of IS were similar in both groups (IHD and NIHD). In total, 32.6% of SP patients received appropriate shock (AS) and 5.3% of them received at least one IS (average number of AS and IS being 8.7 ± 11.5 and 1.1 ± 0.4 respectively). Mortality was significantly higher in SP than in PP (34.8% vs 13.9%, p < 0.001). In PP, significantly more deaths occurred among IHD than NIHD patients (18.8% vs 10.0%, p < 0.001).  Conclusion The prevalence of AS and IS was relatively higher than reported elsewhere. Same was true for mortality. Interestingly, the rate of IS was somewhat higher in NIHD than in IHD, which was unexpected. ICD outcomes Primary prevention Secondary prevention Total IHD NIHD Total IHD NIHD Patients, n 375 165 210 132 88 44 Patients with ICD activation, n (%) 108 (28.8) 46 (27.9) 62 (29.5) 56 (42.4) 33 (37.5) 22 (50.0) Patientns with AS, n (%) 60 (16.0) 27 (16.4) 33 (15.7) 43 (32.6) 29 (33.0) 14 (31.8) Patientns with IS, n (%) 33 (8.8) 4 (2.4) 29 (13.8) 7 (5.3) 5 (5.7) 2 (4.5) AS delivered (mean ± SD) 5.6 ± 13.3 2.7 ± 3.0 8.0 ± 17.4 8.7 ± 11.5 9.9 ± 12.2 9.7 ± 17.6 IS delivered (mean ± SD) 3.2 ± 5.1 1.2 ± 0.5 3.5 ± 5.4 1.1 ± 0.4 1.0 ± 0 3.2 ± 5.2 Deaths, n (%) 52 (13.9) 31 (18.8) 21 (10.0) 46 (34.8) 32 (36.4) 14 (31.8) Time to death (months, mean ± SD) 20.3 ± 13.9 19.9 ± 12.6 21.1 ± 16.5 27.1 ± 25.7 28.9 ± 24.9 22.6 ± 28.1 ICD, implantable cardioverter defibrillator; IHD, ischemic heart disease; NIHD, non-ischemic heart disease; AS, appropriate shock; IS, inappropriate shock

Outcomes of Implantable Cardioverter Defibrillator in Patients with Ischemic Versus Non-Ischemic Heart Disease

2006 ◽  
Vol 12 (6) ◽  
pp. S60
Author(s):  
Anuj R. Shah ◽  
Haris Athar ◽  
Arnoldas Giedrimas ◽  
Danette Guertin ◽  
Dalia Giedrimiene ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Ischemic Heart ◽  
Cardioverter Defibrillator

scholarly journals Increased Remnant Cholesterol Explains Part of Residual Risk of All-Cause Mortality in 5414 Patients with Ischemic Heart Disease

2016 ◽  
Vol 62 (4) ◽  
pp. 593-604 ◽  
Author(s):  
Anne-Marie K Jepsen ◽  
Anne Langsted ◽  
Anette Varbo ◽  
Lia E Bang ◽  
Pia R Kamstrup ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Hazard Ratio ◽  
Residual Risk ◽  
Ischemic Heart ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Remnant Cholesterol

Abstract BACKGROUND Increased concentrations of remnant cholesterol are causally associated with increased risk of ischemic heart disease. We tested the hypothesis that increased remnant cholesterol is a risk factor for all-cause mortality in patients with ischemic heart disease. METHODS We included 5414 Danish patients diagnosed with ischemic heart disease. Patients on statins were not excluded. Calculated remnant cholesterol was nonfasting total cholesterol minus LDL and HDL cholesterol. During 35836 person-years of follow-up, 1319 patients died. RESULTS We examined both calculated and directly measured remnant cholesterol; importantly, however, measured remnant cholesterol made up only 9% of calculated remnant cholesterol at nonfasting triglyceride concentrations <1 mmol/L (89 mg/dL) and only 43% at triglycerides >5 mmol/L (443 mg/dL). Multivariable-adjusted hazard ratios for all-cause mortality compared with patients with calculated remnant cholesterol concentrations in the 0 to 60th percentiles were 1.2 (95% CI, 1.1–1.4) for patients in the 61st to 80th percentiles, 1.3 (1.1–1.5) for the 81st to 90th percentiles, 1.5 (1.1–1.8) for the 91st to 95th percentiles, and 1.6 (1.2–2.0) for patients in the 96th to 100th percentiles (trend, P < 0.001). Corresponding values for measured remnant cholesterol were 1.0 (0.8–1.1), 1.2 (1.0–1.4), 1.1 (0.9–1.5), and 1.3 (1.1–1.7) (trend, P = 0.006), and for measured LDL cholesterol 1.0 (0.9–1.1), 1.0 (0.8–1.2), 1.0 (0.8–1.3), and 1.1 (0.8–1.4) (trend, P = 0.88). Cumulative survival was reduced in patients with calculated remnant cholesterol ≥1 mmol/L (39 mg/dL) vs <1 mmol/L [log-rank, P = 9 × 10−6; hazard ratio 1.3 (1.2–1.5)], but not in patients with measured LDL cholesterol ≥3 mmol/L (116 mg/dL) vs <3 mmol/L [P = 0.76; hazard ratio 1.0 (0.9–1.1)]. CONCLUSIONS Increased concentrations of both calculated and measured remnant cholesterol were associated with increased all-cause mortality in patients with ischemic heart disease, which was not the case for increased concentrations of measured LDL cholesterol. This suggests that increased concentrations of remnant cholesterol explain part of the residual risk of all-cause mortality in patients with ischemic heart disease.

scholarly journals Hemodialysis patients with better coronary flow reserve and nutrition status have surprising prognosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Imaoka ◽  
N Umemoto ◽  
S Oshima
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Ischemic Heart ◽  
Nutrition Status ◽  
Flow Reserve ◽  
All Cause Mortality ◽  
Conventional Risk Factors

Abstract Background In clinical setting, ischemic heart disease is a challenging problem in hemodialysis (HD) population. Coronary flow reserve (CFR) measured by 13 ammonia positron emitting tomography (13NH3PET) is an established and reliable modality for detecting coronary artery disease. Furthermore, some prior studies show CFR is an important and independent predictor for cardiovascular event and mortality. On the other hand, HD patients with malnutrition status have poor prognosis. We have reported about the relationship between cardiovascular events and geriatric nutrition risk index (GNRI). Now, we wonder the predictability of combination of CFR and GNRI. Methods and result We collected 438 consecutive HD patients who received 13NH3PET in our hospital suspected for ischemic heart disease. 29 patients were excluded due to undergoing coronary revascularization within 60 days, 103 patients were excluded due to incomplete database. In total, 306 HD patients were classified into 4 group according the median value of CFR (1.99) and GNRI (97.73); Low CFR Low GNRI group (n=77), High CFR and Low GNRI group (n=76), Low CFR High GNRI group (n=78) and High CFR High GNRI group (n=75). We collected their follow up data up to 1544 days (median 833 days) about all-cause mortality and cardiovascular (CV) mortality. Surprisingly, there is no mortality event in High CFR High GNRI group. We analyzed about all-cause mortality, CV mortality. Kaplan-Meyer analysis shows there are statistically intergroup differences in each (all-cause mortality; log rank p<0.01, CV mortality; log rank p=0.02). Furthermore, we calculated area under the curve (AUC) analysis, net reclassification improvement (NRI) and integrated discrimination improvement (IDI)m adding GNRI and CFR on conventional risk factors. There are intergroup differences for all-cause mortality in AUC [conventional risk factors, +GNRI, +GNRI+CFR; 0.70, 0.72 (p=0.29), 0.79 (p<0.01)], NRI [+GNRI; 0.32 (p=0.04), +GNRI+CFR 0.82 (p<0.01)] and IDI [+GNRI; 0.01 (p=0.05), +GNRI+CFR 0.09 (p<0.01)]. Conclusion HD patients with low CFR and malnutrition status has statistically significant poorer prognosis comparing HD patients with high CFR and without malnutrition status. Adding combination of GNRI and CFR on conventional risk factors improves the predictability of HD population's prognosis. Funding Acknowledgement Type of funding source: None

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