Cardioverter-defibrillator does not improve short-term survival among patients with non-ischemic cardiomyopathy and
Clemens Jilek1, Thorsten Lewalter2, Matthias Pauschinger3
1Peter Osypka Herzzentrum München, Internistisches Klinikum München Süd, Munich, Germany. research@jilek.de.
Insights
Implantable cardioverter-defibrillators (ICDs) benefit ischemic cardiomyopathy patients but not non-ischemic cardiomyopathy patients for sudden cardiac death prevention. Real-world data from the EVITA-HF registry support these findings.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- The DANISH trial questioned the efficacy of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death in non-ischemic heart failure.
- Real-world data are needed to validate these findings.
Purpose of the Study:
- To analyze data from the EVITA-HF registry to evaluate the effectiveness of ICDs in patients with chronic heart failure (CHF).
- To compare survival rates between patients with and without ICDs, stratified by the cause of heart failure.
Main Methods:
- 1804 patients with CHF and left ventricular ejection fraction ≤35% were identified from the EVITA-HF registry.
- Patients were divided into an ICD group (n=331) and a no-ICD group (n=1473).
- Survival and predictive parameters were compared between groups.
Main Results:
- No significant difference in cardiovascular risk factors was observed between the groups.
- After 1-year follow-up, patients with ischemic heart disease showed significantly improved survival with ICDs (92.1% vs. 80.6%).
- Patients with non-ischemic cardiomyopathy did not show a survival difference between ICD and no-ICD groups (93.7% vs. 93.1%).
Conclusions:
- In a real-world setting, ICD therapy does not provide short-term survival benefits for patients with non-ischemic cardiomyopathy and reduced ejection fraction.
- ICD therapy demonstrated a survival benefit in patients with ischemic cardiomyopathy.
- Findings contrast with the DANISH trial, highlighting the importance of etiology in ICD decision-making.
Introduction:
The DANISH trial raised doubts about the effectiveness of primary prevention of sudden cardiac death by ICD implantation among patients with non-ischemic heart failure. We sought to analyse data from the EVITA-HF registry to give an answer from real-world registry data to the DANISH trial.
Methods:
1804 patients were identified from the EVITA-HF registry with chronic heart failure (CHF) due to ischemic or dilated heart disease and reduced left ventricular ejection fraction of ≤ 35%. The patients were divided into two groups: Patients with newly implanted cardioverter-defibrillator (ICD group; mean age 66 ± 12 years, 77% male) and without ICD (no-ICD group; mean age 66 ± 14 years, 77% male). The subgroups were compared with regard to mortality and predictive parameters affecting survival.
Results:
Cardiovascular risk factors were similar among patients in the non-ICD group (n = 1473) compared to ICD group (n = 331). After 1-year follow-up patients with ischemic heart disease showed a significant improved survival in the ICD group compared to non-ICD group [92.1% vs. 80.6%, HR 0.37 (0.22-0.62)]. Patients with non-ischemic cardiomyopathy did not show a difference with regard to survival between the ICD and the non-ICD group [93.7% vs. 93.1%, HR 0.92 (0.43-1.97)]. The data were stable in a Cox-regression model.
Conclusion:
In a real-world setting, no benefit was evident for patients with non-ischemic cardiomyopathy and reduced left ventricular ejection fraction by adding ICD therapy in a short-term follow-up of 12 months in contrast to patients with ischemic cardiomyopathy.
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