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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
Karolinska Inst, Sweden; Univ Heart Ctr Hamburg, Germany; Univ Heart Ctr Hamburg, Germany.
Karolinska Inst, Sweden; Univ Utrecht, Netherlands.
Karolinska Inst, Sweden.
Univ Heart Ctr Hamburg, Germany.
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2019 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 140, no 19, p. 1530-1539Article in journal (Refereed) Published
Abstract [en]

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 amp;gt;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 amp;lt;75 versus amp;gt;= 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.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2019. Vol. 140, no 19, p. 1530-1539
Keywords [en]
defibrillators; implantable; heart failure; primary prevention; registries
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-162326DOI: 10.1161/CIRCULATIONAHA.119.043012ISI: 000494805400006PubMedID: 31476893OAI: oai:DiVA.org:liu-162326DiVA, id: diva2:1374074
Note

Funding Agencies|Boston ScientificBoston Scientific; EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking BigData@Heart grant [116074]; German Research FoundationGerman Research Foundation (DFG)

Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2019-11-28

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Dahlström, Ulf
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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