Key result
Wearable cardioverter defibrillator patients have ~4% 1-year mortality, highest in congenital and inherited heart disease.
Why the study?
One-year outcomes in patients prescribed the wearable cardioverter defibrillator (WCD) had not been reported despite demonstrated efficacy and safety.
Cohort (n=2,000)
Yes
Higher mortality in congenital/inherited disease on wearable defibrillators warrants caution in risk assessment; leaves open whether device use alters outcomes in this subgroup.
BACKGROUND: The WEARIT-II Registry demonstrated efficacy and safety of the wearable cardioverter defibrillator (WCD) for at-risk cardiac patients. However, 1-year outcomes in this population have not been reported. METHODS: The WEARIT-II Registry enrolled 2,000 U.S. patients prescribed the WCD. One-year mortality data from start of WCD use were prospectively collected for 1,846 patients (93%). Outcome data were analyzed by disease etiology and implantable cardioverter defibrillator (ICD) implantation following WCD use. RESULTS: During 12 months of follow-up, 73 patients died (4%). Kaplan-Meier survival analysis showed differences in all-cause mortality from WCD prescription between patients with ischemic versus nonischemic cardiomyopathy versus congenital/inherited heart disease (4% vs 3% vs 7%, P = 0.013). Patients with ventricular arrhythmia events during WCD use had a higher 1-year mortality (10% vs 3%, P = 0.042). Renal disease, increasing age, prior syncope, and nonbeta-blocker use predicted mortality. One-year mortality was similar in patients who did versus did not receive an ICD following WCD use in ischemic (3% vs 4%, P = 0.470) and nonischemic cardiomyopathy (3% vs 3%, P = 0.892). Patients with congenital/inherited heart disease with no implanted ICD had a trend toward a higher rate of mortality than those who received an ICD (8% vs 3%, P = 0.082). Multivariate models confirmed these findings. CONCLUSION: One-year follow-up from the WEARIT-II Registry shows an overall good survival in patients prescribed the WCD. Short-term use of WCD allows appropriate risk stratification for decision on an ICD implantation in at-risk ischemic and nonischemic cardiomyopathy patients. Congenital/inherited heart disease patients had a higher risk of 1-year mortality even without an implanted ICD post-WCD.
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Kutyifa et al. (2018) conducted a cohort in At-risk cardiac disease (n=2,000). Wearable cardioverter defibrillator (WCD) vs. None (or across disease etiologies) was evaluated on 1-year all-cause mortality. In a prospective registry of patients prescribed a wearable cardioverter defibrillator, overall 1-year mortality was 4%, with a higher rate in congenital/inherited heart disease compared to ischemic or nonischemic cardiomyopathy.
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