Key result
Primary prevention ICD plus medical therapy did not significantly reduce the risk of all-cause death compared with medical therapy alone in patients with heart failure and diabetes (HR 0.88; 95% CI 0.7-1.12).
Why the study?
Does a primary prevention implantable cardioverter-defibrillator (ICD) plus medical therapy reduce all-cause death in patients with heart failure or severely reduced ejection fractions and diabetes?
Meta-Analysis (n=3,359)
Yes
Does a primary prevention implantable cardioverter-defibrillator (ICD) plus medical therapy reduce all-cause death in patients with heart failure or severely reduced ejection fractions and diabetes?
Answers are grounded in this paper and cite their sources.
Primary prevention ICDs may not significantly reduce all-cause mortality in patients with heart failure and diabetes, in contrast to the significant benefit observed in patients without diabetes.
AIM: There is limited information on the outcomes after primary prevention implantable cardioverter-defibrillator (ICD) implantation in patients with heart failure (HF) and diabetes. This analysis evaluates the effectiveness of a strategy of ICD plus medical therapy vs. medical therapy alone among patients with HF and diabetes. METHODS AND RESULTS: A patient-level combined-analysis was conducted from a combined dataset that included four primary prevention ICD trials of patients with HF or severely reduced ejection fractions: Multicenter Automatic Defibrillator Implantation Trial I (MADIT I), MADIT II, Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE), and Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). In total, 3359 patients were included in the analysis. The primary outcome of interest was all-cause death. Compared with patients without diabetes (n = 2363), patients with diabetes (n = 996) were older and had a higher burden of cardiovascular risk factors. During a median follow-up of 2.6 years, 437 patients without diabetes died (178 with ICD vs. 259 without) and 280 patients with diabetes died (128 with ICD vs. 152 without). ICDs were associated with a reduced risk of all-cause mortality among patients without diabetes [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.67] but not among patients with diabetes (HR 0.88, 95% CI 0.7-1.12; interaction P = 0.015). CONCLUSION: Among patients with HF and diabetes, primary prevention ICD in combination with medical therapy vs. medical therapy alone was not significantly associated with a reduced risk of all-cause death. Further studies are needed to evaluate the effectiveness of ICDs among patients with diabetes.
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Sharma et al. (2018) conducted a meta-analysis in Heart failure with reduced ejection fraction and diabetes (n=3,359). ICD plus medical therapy vs. Medical therapy alone was evaluated on All-cause death (HR 0.88, 95% CI 0.7-1.12, p=interaction P = 0.015). Primary prevention ICD plus medical therapy did not significantly reduce the risk of all-cause death compared with medical therapy alone in patients with heart failure and diabetes (HR 0.88; 95% CI 0.7-1.12).
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