Why the study?
ICD improves survival compared with amiodarone, but its effectiveness in cancer patients across different cancer stages remains unclear.
Does implantable cardioverter-defibrillator improve all-cause mortality compared to amiodarone in cancer patients?
Does implantable cardioverter-defibrillator improve all-cause mortality compared to amiodarone in cancer patients?
ICD implantation may improve long-term survival compared to amiodarone in cancer patients, particularly those with advanced stage disease.
May support ICD over amiodarone in cancer patients; hypothesis-generating and requires randomized confirmation.
Background Implantable cardioverter‐defibrillator (ICD) has been demonstrated to improve survival outcomes compared to amiodarone. However, this effectiveness in cancer patients remains unclear. Given the complexity of cardiovascular management in this population, including cancer stage considerations, we evaluated the relative effectiveness of ICD versus amiodarone in cancer patients. Methods and Results We linked cancer registry data with administrative records to identify patients newly prescribed amiodarone or who underwent ICD implantation between 2010 and 2015 at 36 hospitals in Osaka Prefecture, Japan. Among 161,125 cancer patients, 339 met the inclusion criteria (amiodarone: n = 281; ICD: n = 58), with a median follow‐up of 762 days. Kaplan–Meier analysis revealed that the ICD group had a significantly reduced risk of all‐cause mortality compared to the Amiodarone group (Log‐rank test, p < .003). Multivariable Cox proportional hazard regression model showed that ICD was an independent prognostic factor (Hazard ratio: 0.47, 95% confidence interval: 0.29–0.79, p = .004). These results were confirmed in a propensity‐matched analysis. Among patients with cancer stage: in situ or localized, no significant difference in survival risk was observed between the ICD and Amiodarone groups, and ICD was not significantly associated with all‐cause death. Conversely, among patients with cancer stage: regional or distant, the ICD group had a significantly reduced risk of all‐cause death compared to the Amiodarone group, and ICD was an independent prognostic factor. Conclusion In cancer patients, ICD may improve long‐term prognosis compared to amiodarone, especially in patients with advanced cancer stages.
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Kida et al. (2025) studied this question.
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