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Frailty Status Modifies the Efficacy of ICD Therapy for Primary Prevention Among Patients With HF

Matthew W Segar1, Neil Keshvani2, Sumitabh Singh2

  • 1Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.

JACC. Heart Failure
|August 11, 2023
PubMed

Insights

Implantable cardioverter-defibrillator (ICD) therapy benefits heart failure patients with reduced ejection fraction (HFrEF) and low frailty. Frailty modifies ICD efficacy, showing no mortality benefit for frail HFrEF patients.

Area of Science:

  • Cardiology
  • Geriatrics
  • Clinical Trials

Background:

  • Implantable cardioverter-defibrillator (ICD) therapy is recommended for reducing mortality in heart failure with reduced ejection fraction (HFrEF).
  • Frailty is prevalent in HFrEF patients and linked to increased mortality.
  • The impact of frailty on ICD efficacy in HFrEF requires clarification.

Purpose of the Study:

  • To assess if baseline frailty modifies the efficacy of ICD therapy for primary prevention in HFrEF patients.
  • Investigate the interaction between frailty burden and ICD treatment effect on all-cause mortality.

Main Methods:

  • Analysis of 1,676 HFrEF participants from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) randomized to ICD or placebo.
  • Frailty was quantified using the Rockwood Frailty Index (FI) and stratified into low (≤ median) and high (> median) burden groups.
  • Multivariable Cox models with interaction terms (frailty × treatment) evaluated frailty's modification of ICD efficacy for mortality.

Main Results:

  • Baseline frailty significantly modified ICD therapy's treatment effect (Pinteraction = 0.047).
  • ICD therapy reduced all-cause mortality in patients with low frailty burden (HR: 0.56; 95% CI: 0.40-0.78).
  • No significant mortality benefit from ICD therapy was observed in patients with high frailty burden (HR: 0.86; 95% CI: 0.68-1.09).

Conclusions:

  • Baseline frailty is a significant modifier of ICD therapy efficacy in HFrEF.
  • A mortality benefit from ICDs was evident in HFrEF patients with low frailty burden.
  • ICD therapy did not demonstrate a mortality benefit in HFrEF patients with high frailty burden.
Abstract

Keywords:
frailtyheart failureimplantable cardioverter-defibrillator

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