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Published on: February 28, 2012
Contemporary Implantable Cardioverter-Defibrillator Benefit: Time to First Therapy in a Large, Real-World Cohort
Anne B Curtis1, Angelo Auricchio2, Suneet Mittal3
1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Insights
Nearly half of patients with implantable cardioverter-defibrillators (ICDs) receive appropriate therapy within 10 years. This confirms the ongoing benefit of ICDs for sudden cardiac death prevention.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for reducing mortality in patients at risk of sudden cardiac death.
- Advances in heart failure management may influence the utilization and effectiveness of ICD therapies.
- An updated assessment of ICD benefit in contemporary patient populations is warranted.
Purpose of the Study:
- To evaluate the time to first therapy in current ICD recipients.
- To estimate the proportion of appropriate ICD therapies using adjudicated data.
- To analyze therapy incidence based on primary versus secondary prevention indications.
Main Methods:
- Analysis of a de-identified database (Medtronic CareLink, 2013-2024) of 237,627 single- or dual-chamber ICD recipients.
- Generation of cumulative incidence curves for shock, antitachycardia pacing (ATP), and any therapy.
- Manual adjudication of 595 randomly selected episodes to assess therapy appropriateness, with results extrapolated to the entire cohort.
Main Results:
- The 10-year cumulative incidence of first appropriate shock, ATP, or any therapy was 33%, 42%, and 48%, respectively.
- Patients receiving ICDs for secondary prevention showed higher rates of appropriate therapy compared to primary prevention patients (e.g., 41% vs. 32% for first appropriate shock at 10 years).
- Male patients constituted 71.8% of the study population.
Conclusions:
- Approximately 48% of contemporary patients receive appropriate ICD therapy within 10 years of implantation.
- These findings underscore the continued clinical benefit of ICDs, even with advancements in cardiac care and device management.
- ICDs remain a vital tool in managing patients at risk for sudden cardiac death.
Background:
Implantable cardioverter-defibrillators (ICDs) reduce mortality in patients at risk of sudden cardiac death. Recent improvements in heart failure care may impact the rate of ICD therapy received by patients. Thus, an updated examination of ICD benefit is needed.
Objectives:
This study sought to assess time to first therapy in contemporary ICD patients and infer the proportion of appropriate therapies based on an adjudicated subset of randomly selected episodes.
Methods:
A query of the Medtronic CareLink de-identified database from 2013 to 2024 was performed. First-time Medtronic ICD recipients implanted with a single- or dual-chamber ICD were included. Cumulative incidence function curves were generated for time to first shock therapy, antitachycardia pacing (ATP) therapy, and any therapy (shock or ATP). Three adjudicators analyzed 595 randomly selected episodes manually to assess appropriateness of therapy. Results from adjudication were then used to model therapy appropriateness of the rest of the episodes in the database.
Results:
There were 237,627 patients (71.8% male) included in the analysis. The cumulative incidence of first appropriate shock, ATP, or any appropriate therapy was 33%, 42%, and 48% at 10 years, respectively. Secondary prevention ICD-indicated patients had a higher 10-year cumulative incidence of first appropriate shock (41% vs 32%), ATP (51% vs 40%), or any appropriate therapy (58% vs 45%) than primary prevention patients.
Conclusions:
Nearly half of contemporary patients receive appropriate ICD therapy by 10 years postimplantation. These data indicate continued benefit of ICD therapy despite modern refinements to device management and medical and interventional cardiac care.
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