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Predicting appropriate shocks in patients with heart failure: Patient level meta-analysis from SCD-HeFT and MADIT II
Emily P Zeitler1, Sana M Al-Khatib1,2, Daniel J Friedman1,2
1Duke University Hospital, Durham, NC, USA.
Journal of Cardiovascular Electrophysiology
|July 27, 2017
Summary
Predicting appropriate shocks in primary prevention implantable cardioverter defibrillators (ICDs) is crucial. Higher NYHA class, lower LVEF, no beta-blocker therapy, and single-chamber ICDs predict appropriate shocks.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Primary prevention implantable cardioverter defibrillators (ICDs) lack precise tools for predicting appropriate shocks.
- Identifying predictors of appropriate shocks is essential for optimizing patient selection and device programming.
Purpose of the Study:
- To identify clinical and demographic characteristics that predict appropriate shocks in patients receiving primary prevention ICDs.
Main Methods:
- A meta-analysis of patient-level data from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).
- Logistic regression analysis was used to identify predictors of appropriate shocks.
Main Results:
- Of 1,463 patients randomized to an ICD, 285 (19%) experienced at least one appropriate shock over a median follow-up of 2.59 years.
- Predictors of appropriate shocks included higher NYHA class, lower left ventricular ejection fraction (LVEF), absence of beta-blocker therapy, and single-chamber ICDs.
Conclusions:
- Higher NYHA class, lower LVEF, no beta-blocker therapy, and single-chamber ICDs are significant predictors of appropriate shocks in primary prevention patients.
- These findings can aid in refining patient selection and management strategies for ICD therapy.
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