Long-Term Outcomes of Implantable Cardioverter-Defibrillator Therapy in the SCD-HeFT.

Autor:	Poole JE; Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington. Electronic address: jpoole@u.washington.edu., Olshansky B; Department of Medicine, Division of Cardiology, University of Iowa, Iowa City, Iowa., Mark DB; Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina., Anderson J; Seattle Institute for Cardiac Research, Seattle, Washington., Johnson G; Seattle Institute for Cardiac Research, Seattle, Washington., Hellkamp AS; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina., Davidson-Ray L; Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina., Fishbein DP; Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington., Boineau RE; National Center for Complementary and Integrative Health, National institutes of Health, Bethesda, Maryland., Anstrom KJ; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina., Reinhall PG; Department of Mechanical Engineering, University of Washington, Seattle, Washington., Packer DL; Department of Cardiology, Division of Cardiac Electrophysiology, Mayo Clinic, Rochester, Minnesota., Lee KL; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina., Bardy GH; Department of Medicine, Division of Cardiology, Seattle Institute for Cardiac Research, Seattle, Washington.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2020 Jul 28; Vol. 76 (4), pp. 405-415.
DOI:	10.1016/j.jacc.2020.05.061
Abstrakt:	Background: The SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) randomized 2,521 patients with moderate heart failure (HF) to amiodarone, placebo drug, or implantable cardioverter-defibrillator (ICD) therapy. Original trial follow-up ended October 31, 2003. Over a median 45.5-month follow-up, amiodarone, compared with placebo, did not affect survival, whereas randomization to an ICD significantly decreased all-cause mortality by 23%. Objectives: This study sought to describe the extended treatment group survival of the SCD-HeFT cohort. Methods: Mortality outcomes for the 1,855 patients alive at the end of the SCD-HeFT trial were collected between 2010 and 2011. These data were combined with the 666 deaths from the original study to compare long-term outcomes overall and for key pre-specified subgroups. Results: Median (25th to 75th percentiles) follow-up was 11.0 (10.0 to 12.2) years. On the basis of intention-to-treat analysis, the ICD group had overall survival benefit versus placebo drug (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.76 to 0.98; p = 0.028). When treatment benefit was examined as a function of time from randomization, attenuation of the ICD benefit was observed after 6 years (p value for the interaction = 0.0015). Subgroup analysis revealed long-term ICD benefit varied according to HF etiology and New York Heart Association (NYHA) functional class: ischemic HF HR: 0.81; 95% CI: 0.69 to 0.95; p = 0.009; nonischemic HF HR: 0.97; 95% CI: 0.79 to 1.20; p = 0.802; NYHA functional class II HR: 0.76; 95% CI: 0.65 to 0.90; p = 0.001; NYHA functional class III HR: 1.06; 95% CI: 0.86 to 1.31; p = 0.575. Conclusions: Follow-up of SCD-HeFT patients to 11 years demonstrated heterogenous treatment-related patterns of long-term survival with ICD benefit most evident at 11 years for ischemic HF patients and for those with NYHA functional class II symptoms at trial enrollment. (SCD-HeFT 10 Year Follow-up [SCD-HeFT10 Yr]; NCT01058837). (Copyright © 2020 American College of Cardiology Foundation. All rights reserved.)
Databáze:	MEDLINE
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