Key result
Appropriate ICD therapy is linked to ~3-fold higher mortality risk in sudden death prevention patients.
Why the study?
Less than 50% of patients implanted with an ICD receive device therapy during follow-up, and the predictive role of appropriate ICD therapy on long-term survival was unclear.
Does appropriate ICD therapy predict long-term mortality in patients implanted with an ICD for primary or secondary sudden death prevention?
Cohort (n=139)
Does appropriate ICD therapy predict long-term mortality in patients implanted with an ICD for primary or secondary sudden death prevention?
Hazard Ratio: 3.02
p-value: p=0.003
In patients with an ICD, receiving appropriate device therapy is a strong predictor of subsequent long-term mortality, likely reflecting underlying disease progression.
Appropriate ICD therapy identifies patients at tripled long-term mortality risk; leaves open whether therapy marks sicker substrate or influences prognosis.
BACKGROUND: Less than 50% of patients implanted with an implantable cardioverter-defibrillator (ICD) receive device therapy during the follow-up. The aim of our study was to prospectively evaluate the predictive role of appropriate ICD therapy on long-term survival of patients implanted for primary or secondary sudden death prevention. METHODS: From 2002 to 2003, 139 consecutive patients [mean age 66±9 years, male 77%, ischemic heart disease 56%, New York Heart Association functional class >II (74%), primary prevention 74%, mean left ventricular ejection fraction 30±9%, cardiac resynchronization ICD 65%] were enrolled. We collected and evaluated device therapies for at least 18 months and recorded survival status for more than 5 years. RESULTS: Over a median follow-up of 18 months, 54 (39%) patients received at least one ICD intervention, with 28 patients receiving only appropriate ICD therapies, 13 only inappropriate therapies and 13 receiving both therapies. At a mean follow-up of 63±12 months, 30 deaths occurred in 130 patients (23%); for nine patients, we had no survival status information. Death was classified as cardiac in 22 (73%) patients, the most common cause was progressive heart failure. In a Cox proportional regression model, an appropriate ICD therapy was associated with a significant increase in the subsequent risk of death (hazard ratio 3.02, P=0.003). CONCLUSION: In patients implanted with ICD or cardiac resynchronization therapy with ICD devices, for primary or secondary sudden cardiac death prevention, appropriate ICD therapy predicts a three-fold greater risk of death.
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Stabile et al. (2012) conducted a cohort in Implantable cardioverter-defibrillator (ICD) recipients (n=139). Appropriate ICD therapy vs. No appropriate ICD therapy was evaluated on Death (HR 3.02, p=0.003). In patients implanted with an ICD for sudden cardiac death prevention, appropriate ICD therapy was associated with a three-fold greater risk of subsequent death (HR 3.02, P=0.003).
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