Key result
In a regional Australian cohort of 82 patients receiving a primary prevention implantable cardiac defibrillator, all-cause mortality was 30.5% over 4.8 years, and only 28% of patients received device therapy.
Why the study?
Despite major advances in treating severe heart failure, determining which patients should receive an implantable cardiac defibrillator remains challenging.
Observational (n=82)
No
In a regional Australian cohort, primary prevention ICDs were associated with a high rate of inappropriate shocks and low appropriate therapy rates, raising questions about patient selection and regional disparities.
High mortality and inappropriate shock burden seen post-primary prevention ICD; leaves open optimal selection and shock minimization in real-world cohorts.
Background: Despite major advances in treating patients with severe heart failure, deciding who should receive an implantable cardiac defibrillator (ICD) remains challenging. Objective: To study the risk factors and mortality in patients after receiving an ICD (Jan 2008-Dec 2015) in a regional hospital in Australia. Methods: Eighty-two primary prevention patients received an ICD for ischemic cardiomyopathy (ICM, n=41) and non-ischemic cardiomyopathy (NICM, n=40) with 4.8-yrs follow-up. One patient had mixed ICM/NICM indications. Ventricular arrhythmias were assessed using intracardiac electrograms. Statistical analysis compared the total population and ICM and NICM groups using Kaplan-Meier for survival, Cox regression for mortality predictors, and binary logistic regression for predictors of ventricular arrhythmias (p<0.05). Results: Major risk factors were hypercholesterolemia (70.7%), hypertension (47.6%), and obesity (41.5%). Severe obstructive sleep apnea (OSA) was found exclusively in NICM patients (23.7%, p=0.001). Mortality was 30.5% after 4.8-yrs. The majority of patients (n=67) had no sustained ventricular arrhythmias yet 28% received therapy (n=23), 18.51% were appropriate (n=15) and 13.9% inappropriate (n=11). Patients receiving 2 incidences of inappropriate shocks were 18-times more likely to die (p=0.013). Three sudden cardiac deaths (SCD) (3.7%) were prevented by the ICD. Conclusion: Patients implanted with an ICD in Townsville had 30.5% all-cause mortality after 4.8-yrs. Only 28% of patients received ICD therapy and 13.9% were inappropriate. OSA may have contributed to the fourfold increase in inappropriate therapy in NICM patients. Our study raises important efficacy, ethical and healthcare cost questions about who should receive an ICD, and possible regional and urban centre disparities.
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Engstrom et al. (2020) conducted an observational in Heart failure (Ischemic and Non-ischemic cardiomyopathy) (n=82). Primary prevention implantable cardiac defibrillator (ICD) was evaluated on All-cause mortality. In a regional Australian cohort of 82 patients receiving a primary prevention implantable cardiac defibrillator, all-cause mortality was 30.5% over 4.8 years, and only 28% of patients received device therapy.
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