Clinical outcome in patients with implantable cardioverter-defibrillator and cancer: a nationwide study.

Abstract

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.

• Authors: Anne M Christensen, Jenny Bjerre, Morten Schou, Christian Jons, Michael Vinther, Gunnar H Gislason, Jens B Johansen, Jens C Nielsen, Helen H Petersen, Sam Riahi, Anne-Christine Ruwald
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 21 Issue 3 Pg. 465-474 (Mar 01 2019) ISSN: 1532-2092 [Electronic] England
• PMID: 30535192 (Publication Type: Journal Article)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: [email protected].

Topics

• Aged
• Death, Sudden, Cardiac (epidemiology, prevention & control)
• Defibrillators, Implantable
• Denmark (epidemiology)
• Electric Countershock (adverse effects, instrumentation, mortality)
• Female
• Heart Diseases (diagnosis, mortality, therapy)
• Humans
• Male
• Middle Aged
• Neoplasms (diagnosis, epidemiology, mortality)
• Primary Prevention (instrumentation)
• Registries
• Risk Assessment
• Risk Factors
• Secondary Prevention (instrumentation)
• Time Factors
• Treatment Outcome