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Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic Implantable Cardioverter

M Juhani Junttila1, Ari Pelli2, Tuomas V Kenttä2

  • 1Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland juhani.junttila@oulu.fi.

Diabetes Care
|October 25, 2019
PubMed

Insights

Patients with diabetes receiving prophylactic implantable cardioverter defibrillators (ICDs) face higher mortality despite fewer shocks. This suggests ICDs may offer limited survival benefits for diabetic patients with heart dysfunction.

Area of Science:

  • Cardiology
  • Diabetology
  • Public Health

Background:

  • Diabetes mellitus is a significant risk factor for cardiovascular disease, including sudden cardiac death (SCD).
  • The mechanisms underlying increased mortality in diabetic patients with cardiac conditions remain incompletely understood.
  • Prophylactic implantable cardioverter-defibrillators (ICDs) are used to prevent SCD, but their effectiveness in diabetic populations requires further investigation.

Purpose of the Study:

  • To compare the incidence of appropriate ICD shocks and all-cause mortality in patients with and without diabetes who received prophylactic ICDs.
  • To elucidate the impact of diabetes on the efficacy of primary prevention ICD therapy.

Main Methods:

  • Retrospective analysis of 3,535 patients from the EU-CERT-ICD registry who received prophylactic ICDs.
  • Patients were stratified based on the presence or absence of diabetes (995 diabetic patients).
  • Primary endpoints included appropriate ICD shocks and all-cause mortality, with a mean follow-up of 3.2 years.

Main Results:

  • Diabetic patients experienced a lower incidence of appropriate ICD shocks (adjusted HR 0.77, P=0.02).
  • Conversely, patients with diabetes exhibited significantly higher all-cause mortality (adjusted HR 1.30, P=0.001).
  • The mean age was 63.7 years, with 82% males, and 28% of patients had diabetes.

Conclusions:

  • All-cause mortality is elevated in diabetic patients with prophylactic ICDs compared to non-diabetic counterparts.
  • The reduced incidence of appropriate shocks in diabetics suggests that excess mortality may not stem primarily from ventricular tachyarrhythmias.
  • Prophylactic ICD therapy may have limitations in improving survival for diabetic patients with impaired left ventricular function.
Abstract

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