Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter‐Defibrillators in the Cardiovascular Research Network

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.

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Comparison of Inappropriate Shocks and Other Health Outcomes Between Single‐ and Dual‐Chamber Implantable Cardioverter‐Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter‐Defibrillators

Journal of the American Heart Association ◽

10.1161/jaha.117.006937 ◽

2017 ◽

Vol 6 (11) ◽

Cited By ~ 8

Author(s):

Pamela N. Peterson ◽

Robert T. Greenlee ◽

Alan S. Go ◽

David J. Magid ◽

Andrea Cassidy‐Bushrow ◽

...

Keyword(s):

Longitudinal Study ◽

Cardiac Death ◽

Research Network ◽

Implantable Cardioverter Defibrillators ◽

Dual Chamber ◽

Cardiovascular Research ◽

Inappropriate Shocks ◽

Cardioverter Defibrillators ◽

Chamber Implantable ◽

Dual Chamber Implantable

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Faculty Opinions recommendation of Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the PREPARE (Primary Prevention Parameters Evaluation) study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4667957.793502162 ◽

2014 ◽

Cited By ~ 1

Author(s):

Joerge Schwab

Keyword(s):

Primary Prevention ◽

Evaluation Study ◽

Implantable Cardioverter Defibrillators ◽

Cardioverter Defibrillators

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

Circulation ◽

10.1161/circ.132.suppl_3.12621 ◽

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.

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