Are defibrillators less useful in patients with non-ischemic heart disease?
Rita Marinheiro1, Leonor Parreira1, Pedro Amador1
1Serviço de Cardiologia, Hospital de São Bernardo - Centro Hospitalar de Setúbal, Setúbal, Portugal.
Insights
Implantable defibrillators provide similar benefits for patients with non-ischemic heart disease (non-IHD) as for those with ischemic heart disease (IHD), showing comparable rates of appropriate shocks and mortality.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Implanted defibrillators are crucial for managing ischemic heart disease (IHD).
- Evidence supporting their use in non-ischemic heart disease (non-IHD) is less extensive.
- Primary prevention strategies require robust data across diverse patient populations.
Purpose of the Study:
- To compare the incidence of appropriate shocks and all-cause mortality in patients with non-IHD versus IHD receiving defibrillators for primary prevention.
- To evaluate the efficacy and safety of defibrillator implantation in non-IHD patients.
Main Methods:
- Retrospective single-center study of patients implanted with defibrillators or cardiac resynchronization therapy-defibrillators between 2004 and 2014.
- Patients were categorized into IHD and non-IHD groups.
- Composite endpoint: appropriate shock and all-cause mortality; Kaplan-Meier analysis used.
Main Results:
- 281 patients studied; 187 (66%) had IHD. IHD patients were older, more male, and had more risk factors.
- Appropriate shock incidence: 18% in IHD vs. 21% in non-IHD (p=0.64).
- All-cause mortality: 47% in IHD vs. 38% in non-IHD (p=0.19). Survival curves showed no significant difference (log-rank p=0.10).
Conclusions:
- No significant differences in appropriate shocks or all-cause mortality were observed between IHD and non-IHD groups.
- Defibrillator therapy appears equally effective for primary prevention in both patient cohorts.
- Further research may explore specific non-IHD subgroups.
Introduction And Objective:
The benefits of implanted defibrillators in patients with ischemic heart disease (IHD) are well known. However, the evidence is less robust in patients with non-ischemic heart disease (non-IHD). We aimed to determine whether patients with non-IHD have a similar incidence of appropriate shocks and all-cause mortality compared to those with IHD.
Methods:
In a retrospective single-center study we analyzed all patients with implantable cardioverter-defibrillators or cardiac resynchronization therapy-defibrillators implanted for primary prevention between 2004 and 2014. The population was divided into two groups: patients with IHD and patients with non-IHD. The composite endpoint was appropriate shock and all-cause mortality.
Results:
Two hundred and eighty-one patients were studied, of whom 187 (66%) had IHD. Patients with IHD were older, more frequently male and with more cardiovascular risk factors. Mean follow-up was 55±42 months. Thirty-four patients (18%) with IHD and 20 patients (21%) with non-IHD had an appropriate shock (p=0.64). Eighty-nine patients (47%) with IHD and 36 (38%) with non-IHD died during follow-up (p=0.19). The rate of shocks or death over time was similar in patients with IHD and non-IHD according to Kaplan-Meier survival curve analysis (log-rank p=0.10).
Conclusion:
In this population, there were no differences in appropriate shocks or all-cause mortality in the two groups.
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