Extending Survival by Reducing Sudden Death with Implantable Cardioverter-Defibrillators: A Challenging Clinical Issue in Non-Ischaemic and Ischaemic Cardiomyopathies
Key result
Implantable cardioverter-defibrillators for primary prevention reduce all-cause mortality in younger patients (<65-70 years) with heart failure, but this benefit is attenuated in older patients.
Why the study?
Does ICD implantation for primary prevention reduce all-cause mortality in patients with heart failure, and does this benefit vary by age?
Structured PICO
Does ICD implantation for primary prevention reduce all-cause mortality in patients with heart failure, and does this benefit vary by age?
P
Population
Patients with heart failure and left ventricular systolic dysfunction (ischaemic and non-ischaemic aetiology) evaluated for primary prevention of sudden cardiac death
I
Intervention
Implantable cardioverter-defibrillator (ICD) for primary prevention
C
Comparator
Usual care / optimized medical treatment without ICD
O
Outcome
All-cause mortalityhard clinical
ICD therapy for primary prevention in heart failure provides a significant survival benefit in younger patients, but this benefit is attenuated in the elderly due to competing non-arrhythmic mortality risks.
Limitations
- Improvements in pharmacological and non-pharmacological treatments over time may limit the applicability of older trial results when compared to recent trials.
- Competing risks of death from co-morbidities in the elderly complicate the estimation of ICD benefit.
- Differences in background pharmacological treatments between older and more recent trials
- Competing risks of death from non-arrhythmic and non-cardiovascular causes in elderly patients with multiple comorbidities
Authors
Discussion
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Implication
Supports broader ICD use in HF; extends RCT evidence via contemporary meta-analysis.
Cite This Study
Boriani et al. (2017) conducted a review in Heart failure with left ventricular systolic dysfunction (ischaemic and non-ischaemic cardiomyopathy). Implantable Cardioverter-Defibrillator (ICD) vs. Usual care / Control was evaluated. Implantable cardioverter-defibrillators for primary prevention reduce all-cause mortality in younger patients (<65-70 years) with heart failure, but this benefit is attenuated in older patients.