Association Between Use of Primary-Prevention Implantable Cardioverter-Defibrillators and Mortality in Patients With Heart Failure: A Prospective Propensity Score-Matched Analysis From the Swedish Heart Failure Registry
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Association Between Use of Primary-Prevention Implantable Cardioverter-Defibrillators and Mortality in Patients With Heart Failure: A Prospective Propensity Score-Matched Analysis From the Swedish Heart Failure Registry. / Schrage, Benedikt; Uijl, Alicia; Benson, Lina; Westermann, Dirk; Ståhlberg, Marcus; Stolfo, Davide; Dahlström, Ulf; Linde, Cecilia; Braunschweig, Frieder; Savarese, Gianluigi.
in: CIRCULATION, Jahrgang 140, Nr. 19, 05.11.2019, S. 1530-1539.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Association Between Use of Primary-Prevention Implantable Cardioverter-Defibrillators and Mortality in Patients With Heart Failure: A Prospective Propensity Score-Matched Analysis From the Swedish Heart Failure Registry
AU - Schrage, Benedikt
AU - Uijl, Alicia
AU - Benson, Lina
AU - Westermann, Dirk
AU - Ståhlberg, Marcus
AU - Stolfo, Davide
AU - Dahlström, Ulf
AU - Linde, Cecilia
AU - Braunschweig, Frieder
AU - Savarese, Gianluigi
PY - 2019/11/5
Y1 - 2019/11/5
N2 - BACKGROUND: Most randomized trials on implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death in heart failure with reduced ejection fraction enrolled patients >20 years ago. We investigated the association between ICD use and all-cause mortality in a contemporary heart failure with reduced ejection fraction cohort and examined relevant subgroups.METHODS: Patients from the Swedish Heart Failure Registry fulfilling the European Society of Cardiology criteria for primary-prevention ICD were included. The association between ICD use and 1-year and 5-year all-cause and cardiovascular (CV) mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort and in prespecified subgroups.RESULTS: Of 16 702 eligible patients, only 1599 (10%) had an ICD. After matching, 1305 ICD recipients were compared with 1305 nonrecipients. ICD use was associated with a reduction in all-cause mortality risk within 1 year (hazard ratio, 0.73 [95% CI, 0.60-0.90]) and 5 years (hazard ratio, 0.88 [95% CI, 0.78-0.99]). Results were consistent in all subgroups including patients with versus without ischemic heart disease, men versus women, those aged <75 versus ≥75 years, those with earlier versus later enrollment in the Swedish heart failure registry, and patients with versus without cardiac resynchronization therapy.CONCLUSIONS: In a contemporary heart failure with reduced ejection fraction population, ICD for primary prevention was underused, although it was associated with reduced short- and long-term all-cause mortality. This association was consistent across all the investigated subgroups. These results call for better implementation of ICD therapy.
AB - BACKGROUND: Most randomized trials on implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death in heart failure with reduced ejection fraction enrolled patients >20 years ago. We investigated the association between ICD use and all-cause mortality in a contemporary heart failure with reduced ejection fraction cohort and examined relevant subgroups.METHODS: Patients from the Swedish Heart Failure Registry fulfilling the European Society of Cardiology criteria for primary-prevention ICD were included. The association between ICD use and 1-year and 5-year all-cause and cardiovascular (CV) mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort and in prespecified subgroups.RESULTS: Of 16 702 eligible patients, only 1599 (10%) had an ICD. After matching, 1305 ICD recipients were compared with 1305 nonrecipients. ICD use was associated with a reduction in all-cause mortality risk within 1 year (hazard ratio, 0.73 [95% CI, 0.60-0.90]) and 5 years (hazard ratio, 0.88 [95% CI, 0.78-0.99]). Results were consistent in all subgroups including patients with versus without ischemic heart disease, men versus women, those aged <75 versus ≥75 years, those with earlier versus later enrollment in the Swedish heart failure registry, and patients with versus without cardiac resynchronization therapy.CONCLUSIONS: In a contemporary heart failure with reduced ejection fraction population, ICD for primary prevention was underused, although it was associated with reduced short- and long-term all-cause mortality. This association was consistent across all the investigated subgroups. These results call for better implementation of ICD therapy.
KW - Aged
KW - Aged, 80 and over
KW - Death, Sudden, Cardiac/epidemiology
KW - Defibrillators, Implantable/trends
KW - Electric Countershock/adverse effects
KW - Female
KW - Heart Failure/diagnosis
KW - Humans
KW - Male
KW - Middle Aged
KW - Practice Patterns, Physicians'/trends
KW - Primary Prevention/trends
KW - Propensity Score
KW - Registries
KW - Risk Assessment
KW - Risk Factors
KW - Sweden/epidemiology
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1161/CIRCULATIONAHA.119.043012
DO - 10.1161/CIRCULATIONAHA.119.043012
M3 - SCORING: Journal article
C2 - 31476893
VL - 140
SP - 1530
EP - 1539
JO - CIRCULATION
JF - CIRCULATION
SN - 0009-7322
IS - 19
ER -