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Estimated Glomerular Filtration Rate and Implantable Cardioverter-Defibrillator in Nonischemic Systolic Heart
Seiko N Doi1, Jens Jakob Thune2,3, Jens C Nielsen4,5
1Department of Cardiology Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark.
Insights
Implantable cardioverter-defibrillators (ICDs) did not lower overall mortality in heart failure patients with chronic kidney disease (CKD). However, ICDs reduced sudden cardiac death risk, irrespective of kidney function.
Area of Science:
- Cardiology
- Nephrology
- Clinical Trials
Background:
- Heart failure and chronic kidney disease (CKD) increase mortality risk.
- Implantable cardioverter-defibrillators (ICDs) are used for arrhythmic death prevention.
- The impact of CKD on ICD efficacy requires further investigation.
Purpose of the Study:
- To evaluate the long-term effects of prophylactic ICD implantation versus usual care.
- To assess ICD efficacy based on baseline chronic kidney disease (CKD) status.
- To analyze outcomes in patients with nonischemic systolic heart failure.
Main Methods:
- Extended follow-up of the DANISH trial.
- Randomized controlled trial comparing ICD implantation to usual care.
- Analysis of outcomes stratified by CKD status (eGFR <60 mL/min/1.73 m²).
Main Results:
- ICD implantation did not reduce all-cause mortality or cardiovascular death, regardless of CKD status.
- No significant interaction was found between CKD status and ICD treatment for mortality outcomes.
- Sudden cardiovascular death reduction by ICDs was not modified by baseline CKD status.
Conclusions:
- ICD implantation does not reduce overall mortality in patients with nonischemic heart failure with reduced ejection fraction, irrespective of CKD.
- ICDs effectively reduce sudden cardiovascular death in this patient group, regardless of kidney function.
- CKD status does not alter the benefit of ICDs for preventing sudden cardiac death.
Background:
Patients with heart failure and chronic kidney disease (CKD) may have an increased risk of death from causes competing with arrhythmic death, which could have implications for the efficacy of implantable cardioverter-defibrillators (ICDs). We examined the long-term effects of primary prophylactic ICD implantation, compared with usual care, according to baseline CKD status in an extended follow-up study of DANISH (Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality).
Methods And Results:
In the DANISH trial, 1116 patients with nonischemic heart failure with reduced ejection fraction were randomized to receive an ICD (N=556) or usual care (N=550). Outcomes were analyzed according to CKD status (estimated glomerular filtration rate ≥/<60 mL/min per 1.73 m2) at baseline. In total, 1113 patients had an available estimated glomerular filtration rate measurement at baseline (median estimated glomerular filtration rate 73 mL/min per 1.73 m2), and 316 (28%) had CKD. During a median follow-up of 9.5 years, ICD implantation, compared with usual care, did not reduce the rate of all-cause mortality (no CKD, HR, 0.82 [95% CI, 0.64-1.04]; CKD, HR, 1.02 [95% CI, 0.75-1.38]; Pinteraction=0.31) or cardiovascular death (no CKD, HR, 0.77 [95% CI, 0.58-1.03]; CKD, HR, 1.05 [95% CI, 0.73-1.51]; Pinteraction=0.20), irrespective of baseline CKD status. Similarly, baseline CKD status did not modify the beneficial effects of ICD implantation on sudden cardiovascular death (no CKD, HR, 0.57 [95% CI, 0.32-1.00]; CKD, HR, 0.65 [95% CI, 0.34-1.24]; Pinteraction=0.70).
Conclusions:
ICD implantation, compared with usual care, did not reduce the overall mortality rate, but it did reduce the rate of sudden cardiovascular death, regardless of baseline kidney function in patients with nonischemic heart failure with reduced ejection fraction.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT00542945.
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