Related Experiment Video
Updated: Jun 12, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Implantable cardioverter-defibrillators confer survival benefit in patients with chronic obstructive pulmonary
Eathar Razak1, Swapna Kamireddy, Samir Saba
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Insights
Implantable cardioverter-defibrillators (ICDs) reduce mortality in patients with reduced ejection fraction. This study shows ICDs also benefit patients with chronic obstructive pulmonary disease (COPD), improving survival rates.
Area of Science:
- Cardiology
- Pulmonology
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) are proven to reduce mortality in patients with left ventricular ejection fraction (LVEF) ≤ 35%.
- The survival benefit of ICDs in patients with co-existing chronic obstructive pulmonary disease (COPD) remains unclear.
Purpose of the Study:
- To evaluate the impact of ICDs on total mortality in patients with both LVEF ≤ 35% and COPD.
Main Methods:
- Retrospective analysis of medical records for patients with LVEF ≤ 35% and COPD.
- Matching ICD recipients with controls by age and LVEF.
- Utilizing Charlson comorbidity index and propensity scores for bias correction.
Main Results:
- The study included 100 patients (30 ICD, 70 controls), mean age 65 ± 15 years.
- ICD patients showed significantly lower 2-year mortality (88% vs. 59%, P = 0.016).
- This survival benefit persisted after adjusting for QRS duration, race, and steroid use (adjusted P = 0.016).
Conclusions:
- Patients with COPD and reduced LVEF derive a significant survival benefit from ICD implantation.
- ICD therapy should not be withheld from eligible patients with COPD due to their respiratory condition.
Background:
The prophylactic use of the implantable cardioverter-defibrillator (ICD) has been shown to decrease mortality in patients with depressed left ventricular ejection function (LVEF ≤ 35%). Whether this beneficial effect persists in the presence of chronic obstructive pulmonary disease (COPD) is not established.
Methods:
We examined the medical records of patients with LVEF ≤ 35% and COPD and analyzed the data for total mortality by ICD status. Each ICD patient was matched by age and LVEF with two to three controls. The Charlson comorbidity index and propensity score were used to correct for differences in comorbidities and biases between the study groups.
Results:
A total of 100 patients (30 with ICD and 70 controls) were included in this analysis. The overall cohort had a mean age of 65 ± 15 years with a predominance of white (79%) men (72%). Compared to controls, ICD patients had a wider QRS complex (150 ± 32 ms vs 110 ± 24 ms, P < 0.001) and were less likely to be on steroid therapy (10% vs 31%, P = 0.018) for COPD. At a mean follow-up of 3.1 ± 2.7 years, ICD patient had a lower total mortality (2-year survival of 88% in the ICD group vs 59% in the controls, P = 0.016). The lower death rate in the ICD group persisted after correcting for differences in the QRS interval and for discrepancies race and in the incidence of steroid use in a multivariate Cox regression model (odds ratio = 0.300, adjusted P = 0.016).
Conclusion:
Patients with COPD extract survival benefit from the ICD and should therefore not be denied this life-saving therapy.
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:29Chronic Obstructive Pulmonary Disease-V: Management
Smoking Cessation
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:24Chronic Obstructive Pulmonary Disease
Smoking is a primary risk factor for COPD, with over 80% of patients having a history of it. Patients typically experience progressive dyspnea or labored breathing, frequent coughing, and recurrent pulmonary infections. Many eventually succumb to respiratory failure, characterized by...
01:26COPD: Management Using Bronchodilators and Corticosteroids