July 8, 2026Circulation
Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients With Nonischemic Systolic Heart Failure
Key result
Primary prevention ICDs reduce mortality ~30% in nonischemic systolic heart failure patients aged ≤70 years.
- HR 0.70
- 95% CI 0.51-0.96
- P=0.03
- n=1,116
Why the study?
The DANISH trial suggested a possible age-dependent association between primary prevention ICDs and mortality in nonischemic systolic heart failure, warranting further investigation into the relationship between age and outcome.
Does primary prevention ICD implantation reduce all-cause mortality in patients with nonischemic systolic heart failure, and is this effect age-dependent?
Population
1116 patients with nonischemic systolic heart failure from the DANISH study
Comparison
ICD implantation vs control evaluated across age groups
Design
Prespecified subgroup analysis of a randomized controlled trial
Authors
Discussion
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Member takes
Implication
May support age-stratified ICD decisions in nonischemic HF; leaves open prospective confirmation of age interaction.
Key Points
- To investigate the relationship between age and mortality outcomes following ICD implantation in nonischemic systolic heart failure patients.
- Included all 1116 patients from the DANISH study for subgroup analysis.
- Assessed the relationship between ICD implantation and mortality by age using selection impact curves.
- Compared modes of death between patients ≤70 years and >70 years using χ 2 analysis.
- A linearly decreasing relationship between ICD implantation and mortality was observed (HR, 1.03; 95% CI, 1.003–1.06; P =0.03).
- Patients ≤70 years had reduced all-cause mortality with ICD (HR, 0.70; 95% CI, 0.51–0.96; P =0.03), while those >70 years did not.
- Significant difference in modes of death between age groups (P =0.01).
Study Design
Type
RCT (n=1,116)
Structured PICO
Does primary prevention ICD implantation reduce all-cause mortality in patients with nonischemic systolic heart failure, and is this effect age-dependent?
P
Population
1,116 patients with nonischemic systolic heart failure (median age 63 years) from the DANISH study, analyzed to assess age-dependent outcomes of primary prevention ICDs.
I
Intervention
Primary prevention Implantable Cardioverter-Defibrillator (ICD)
C
Comparator
Control group (no ICD)
O
Outcome
All-cause mortalityhard clinical
Main Result
Hazard Ratio: 0.7 (95% CI 0.51–0.96)
p-value: p=0.03
Primary prevention ICDs provide a survival benefit in patients with nonischemic systolic heart failure who are ≤70 years old, but not in older patients.
Cite This Study
Elming et al. (2017) conducted an RCT in Nonischemic systolic heart failure (n=1,116). Primary prevention implantable cardioverter-defibrillator (ICD) vs. No ICD was evaluated on All-cause mortality in patients ≤70 years of age (HR 0.70, 95% CI 0.51-0.96, p=0.03). Primary prevention ICD implantation reduced all-cause mortality in patients with nonischemic systolic heart failure aged ≤70 years (HR 0.70; 95% CI 0.51-0.96; P=0.03).