Key result
Implantable cardioverter-defibrillator therapy in patients with non-ischemic cardiomyopathy decreased all-cause mortality with borderline significance compared to optimal pharmacological treatment.
Why the study?
Recent data indicated no mortality benefit from ICD therapy compared to optimal medical treatment in non-ischemic cardiomyopathy, significantly affecting clinical practice despite unchanged guideline recommendations.
Does implantable cardioverter-defibrillator (ICD) implantation reduce all-cause mortality and sudden cardiac death in patients with non-ischemic cardiomyopathy heart failure?
Meta-Analysis (n=1,789)
Does implantable cardioverter-defibrillator (ICD) implantation reduce all-cause mortality and sudden cardiac death in patients with non-ischemic cardiomyopathy heart failure?
ICD implantation in patients with non-ischemic cardiomyopathy significantly reduces sudden cardiac death and shows a strong trend toward reducing all-cause mortality compared to optimal medical therapy.
Answers are grounded in this paper and cite their sources.
Trend toward lower all-cause mortality with ICDs in non-ischemic cardiomyopathy; reinforces SCD reduction but leaves definitive survival benefit open.
BACKGROUND: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD) therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation did not change, it is worth noting that these findings significantly affected the daily practice of ICD implantation in Europe. METHODS: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non- -ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the available carefully designed prospective randomized controlled trials. Only prospective randomized controlled trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH. RESULTS: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789 patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67-1.01); p = 0.06. The data from the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI 0.31-0.67); p < 0.001. CONCLUSIONS: In comparison with optimal medical treatment, ICD implantation in patients with heart failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards all-cause mortality reduction.
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Wasiak et al. (2021) conducted a meta-analysis in Non-ischemic cardiomyopathy heart failure (n=1,789). Implantable cardioverter-defibrillator (ICD) vs. Optimal pharmacological treatment / conventional care was evaluated on All-cause mortality (HR 0.48, 95% CI 0.67-1.01, p=0.06). Implantable cardioverter-defibrillator therapy in patients with non-ischemic cardiomyopathy decreased all-cause mortality with borderline significance compared to optimal pharmacological treatment.
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