Key result
ICD implantation in patients awaiting heart transplant was associated with decreased total mortality and sudden cardiac death, as well as higher rates of heart transplantation.
Why the study?
ICD is not routinely implanted in end-stage heart failure due to pump failure risk, but patients awaiting heart transplantation represent a distinct group where prolonged survival improves transplant chances.
Does implantable cardioverter-defibrillator (ICD) implantation reduce mortality in end-stage heart failure patients awaiting heart transplantation?
Meta-Analysis
Does implantable cardioverter-defibrillator (ICD) implantation reduce mortality in end-stage heart failure patients awaiting heart transplantation?
In patients with end-stage heart failure awaiting heart transplantation, ICD implantation is associated with improved survival and higher rates of receiving a transplant.
Answers are grounded in this paper and cite their sources.
Supports ICD consideration to improve survival in transplant candidates; extends observational evidence but requires randomized trials.
BACKGROUND: Patients with end-stage heart failure are at high risk for sudden cardiac death. However, implantable cardioverter-defibrillator (ICD) is not routinely implanted given the high competing risk of pump failure. A unique population worth separate consideration are patients with end-stage heart failure awaiting heart transplantation, as prolonged survival improves the chances of receiving transplant. OBJECTIVE: To compare clinical outcomes of heart failure patients with and without an ICD awaiting heart transplant. METHODS: We performed an extensive literature search and systematic review of studies that compared end-stage heart failure patients with and without an ICD awaiting heart transplantation. We separately assessed the rates of total mortality, sudden cardiac death, nonsudden cardiac death, and heart transplantation. Risk ratio (RR) and 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used owing to heterogeneity across study cohorts. CONCLUSION: ICD implantation is associated with improved outcomes in patients awaiting heart transplant, characterized by decreased total mortality and sudden cardiac death as well as higher rates of heart transplantation.
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Lin et al. (2021) conducted a meta-analysis in End-stage heart failure awaiting heart transplantation. Implantable cardioverter-defibrillator (ICD) vs. No ICD was evaluated on Total mortality, sudden cardiac death, nonsudden cardiac death, and heart transplantation (p== .07). ICD implantation in patients awaiting heart transplant was associated with decreased total mortality and sudden cardiac death, as well as higher rates of heart transplantation.
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