Implantable cardioverter-defibrillators in heart failure patients with reduced ejection fraction and diabetes.

Abstract

AIM:

There is limited information on the outcomes after primary prevention implantable cardioverter-defibrillator (ICD) implantation in patients with heart failure (HF) and diabetes. This analysis evaluates the effectiveness of a strategy of ICD plus medical therapy vs. medical therapy alone among patients with HF and diabetes.

METHODS AND RESULTS:

A patient-level combined-analysis was conducted from a combined dataset that included four primary prevention ICD trials of patients with HF or severely reduced ejection fractions: Multicenter Automatic Defibrillator Implantation Trial I (MADIT I), MADIT II, Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE), and Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). In total, 3359 patients were included in the analysis. The primary outcome of interest was all-cause death. Compared with patients without diabetes (n = 2363), patients with diabetes (n = 996) were older and had a higher burden of cardiovascular risk factors. During a median follow-up of 2.6 years, 437 patients without diabetes died (178 with ICD vs. 259 without) and 280 patients with diabetes died (128 with ICD vs. 152 without). ICDs were associated with a reduced risk of all-cause mortality among patients without diabetes [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.67] but not among patients with diabetes (HR 0.88, 95% CI 0.7-1.12; interaction P = 0.015).

CONCLUSION:

Among patients with HF and diabetes, primary prevention ICD in combination with medical therapy vs. medical therapy alone was not significantly associated with a reduced risk of all-cause death. Further studies are needed to evaluate the effectiveness of ICDs among patients with diabetes.

• Authors: Abhinav Sharma, Sana M Al-Khatib, Justin A Ezekowitz, Lauren B Cooper, Christopher B Fordyce, G Michael Felker, Gust H Bardy, Jeanne E Poole, J Thomas Bigger, Alfred E Buxton, Arthur J Moss, Daniel J Friedman, Kerry L Lee, Richard Steinman, Paul Dorian, Riccardo Cappato, Alan H Kadish, Peter J Kudenchuk, Daniel B Mark, Eric D Peterson, Lurdes Y T Inoue, Gillian D Sanders
• Journal: European journal of heart failure (Eur J Heart Fail) Vol. 20 Issue 6 Pg. 1031-1038 (06 2018) ISSN: 1879-0844 [Electronic] England
• PMID: 29761861 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)
• Copyright: © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.

Topics

• Comorbidity (trends)
• Death, Sudden, Cardiac (epidemiology, etiology, prevention & control)
• Defibrillators, Implantable
• Diabetes Mellitus (epidemiology)
• Female
• Heart Failure (epidemiology, physiopathology, therapy)
• Humans
• Incidence
• Male
• Middle Aged
• Primary Prevention (methods)
• Stroke Volume (physiology)
• Survival Rate (trends)
• United States (epidemiology)