Wearable cardioverter-defibrillator use reduced all-cause death by 26% and heart failure hospitalization by 26% but increased VT/VF diagnosis and ICD implantation risk.
Does a wearable cardioverter-defibrillator reduce all-cause mortality and heart failure hospitalization in patients at high risk of sudden cardiac death compared to beta-blocker therapy alone?
In a real-world propensity-matched cohort, the use of a wearable cardioverter-defibrillator in patients at high risk for sudden cardiac death was associated with significantly lower all-cause mortality and heart failure hospitalization compared to beta-blocker therapy alone.
Absolute Event Rate: 0% vs 0%
Abstract Background While implantable cardioverter-defibrillators (ICD) are effective for long-term prevention, their use is contraindicated during certain high-risk periods. The wearable cardioverter-defibrillator (WCD) offers temporary protection for patients at transient high risk of sudden cardiac death (SCD). The VEST randomized controlled trial shown mixed results with the WCD, particularly regarding arrhythmic mortality, while observational studies support its safety and efficacy although none of the large registries had a control group of patients not treated with WCD. Purpose This study aims to evaluate the clinical outcomes associated with WCD use compared to beta-blocker therapy without WCD in patients at high risk of SCD in a real-world setting. Methods The TriNetX Research Network provides access to electronic health records for approximately 151 million de-identified patients from 135 healthcare organizations in 18 countries. We identified patients over 18 years old treated with WCD or beta-blockers without WCD, all having in the previous 45 days a diagnosis of myocardial infarction, endocarditis, heart failure (HF) or left ventricular ejection fraction (LVEF) 40%, ventricular tachycardia or chronic coronary artery disease (CAD) using relevant ICD-10 and CPT codes. The outcomes of interest were all-cause death, atrial or ventricular arrhythmia, cardiac arrest, ICD implantation and hospitalization for HF during follow-up. Results Among 1,697,462 patients at risk of SCD, 1292 patients were treated with WCD and 1,696,170 patients were treated with beta-blockers and no WCD. After PSM, 1,237 patients remained in each cohort and both cohorts were well-matched on all characteristics: 86-88% of them had HF, 72-73% had CAD, 5% had a history of endocarditis, 4% had a history of previous cardiac arrest and 23-24% had a previous ICD implantation. During follow-up (median 180 days), WCD use was associated with a lower risk of all-cause death (HR 0.74, 95%CI 0.60-0.90) and of hospitalization for HF (HR 0.74, 0.63-0.88) and significantly higher risk of diagnosing VT/VF than beta-blocker use with no WCD (HR 1.49, 95%CI 1.26-1.75). There was a non-significant numerically lower risk of cardiac arrest with WCD use (HR 0.92, 95%CI 0.59-1.44) and a significantly higher rate of ICD implantation during FU in patients treated with WCD (HR 3.92, 95%CI 3.04-5.05) (Table). Conclusion In this relatively large controlled analysis of patients with a significant risk of SCD, WCD use was associated with a lower risk of all-cause mortality and hospitalization for HF than the use of beta-blocker with no WCD, and a higher rate of diagnosis of VT/VF and subsequent implantation (or reimplantation) of ICD. Further studies may still be needed to better evaluate the usefulness of WCD for relevant subgroups of patients in this setting.
Fauchier et al. (Sat,) reported a other. Wearable cardioverter-defibrillator use reduced all-cause death by 26% and heart failure hospitalization by 26% but increased VT/VF diagnosis and ICD implantation risk.