Key result
Pre-existing cancer does not alter appropriate ICD therapy risk but is linked to higher mortality.
Why the study?
Patients with cancer are underrepresented in randomized clinical trials investigating ICD efficacy, necessitating outcome data in this population.
Cohort (n=5,665)
Yes
Similar appropriate ICD therapy rates regardless of cancer status; leaves open optimal selection for secondary prevention ICDs in cancer.
AIMS: Patients with cancer are insufficiently represented in randomized clinical trials investigating efficacy of implantable cardioverter-defibrillators (ICDs). We aimed to describe outcomes in patients with a pre-existing diagnosis of cancer at time of ICD implantation. METHODS AND RESULTS: We utilized Danish nationwide registries to identify primary and secondary prevention ICD implantations from 2007 to 2012. Multivariable Cox models were used to assess the risk of appropriate ICD therapy and mortality in patients with and without cancer at time of implantation. During a median follow-up of 2.1 years, 2935 primary prevention ICD and 2730 secondary prevention ICD implantations were identified. Out of these [289 (5.1%)] had pre-existing cancer [primary 140 (4.8%), secondary 149 (5.5%)]. No differential risk for appropriate ICD therapy was found between patients with or without cancer, [primary cancer: 19/140, no cancer: 380/2795, hazard ratio (HR) = 1.07 (0.67-1.69)] and [secondary cancer: 42/149, no cancer: 699/2581, HR = 1.28 (0.93-1.75)]. In primary patients, cancer was not associated with higher risk of 1-year [cancer: 10/140, no cancer: 133/2795, HR = 1.20 (0.84-2.28)] or all-time mortality [cancer: 22/140, no cancer: 339/2795, HR = 1.13 (0.74-1.75)]. In secondary patients, cancer was associated with a higher 1-year [cancer: 19/149, no cancer: 108/2581, HR = 2.62 (1.60-4.29)] and all-time mortality [cancer: 44/149, no cancer: 315/2581, HR = 2.36 (1.71-3.24)]. CONCLUSION: Implantable cardioverter-defibrillators were implanted in a minority of cancer patients. No difference in risk of appropriate therapy was observed between cancer and non-cancer patients, regardless of implant indication. Cancer was associated with increased mortality in secondary prevention ICD patients, but not in primary prevention ICD patients. In secondary prevention ICD patients, the majority of deaths were attributable to cancer.
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Christensen et al. (2018) conducted a cohort in Implantable cardioverter-defibrillator (ICD) indication (n=5,665). Pre-existing cancer vs. No cancer was evaluated on Appropriate ICD therapy in primary prevention patients (HR 1.07, 95% CI 0.67-1.69). Pre-existing cancer in ICD patients did not alter the risk of appropriate therapy (primary HR 1.07; secondary HR 1.28) but increased mortality in secondary prevention patients (HR 2.36).
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