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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Sharma, A; Al-Khatib, SM; Ezekowitz, JA; Cooper, LB; Fordyce, CB; Michael Felker, G; Bardy, GH; Poole, JE; Thomas Bigger, J; Buxton, AE; Moss, AJ; Friedman, DJ; Lee, KL; Steinman, R; Dorian, P; Cappato, R; Kadish, AH; Kudenchuk, PJ; Mark, DB; Peterson, ED; Inoue, LYT; Sanders, GD

Published Date

  • June 2018

Published In

Volume / Issue

  • 20 / 6

Start / End Page

  • 1031 - 1038

PubMed ID

  • 29761861

Pubmed Central ID

  • 29761861

Electronic International Standard Serial Number (EISSN)

  • 1879-0844

Digital Object Identifier (DOI)

  • 10.1002/ejhf.1192

Language

  • eng

Conference Location

  • England