Outcomes of Implantable Cardioverter-Defibrillator Use in Patients With Comorbidities
| Autor: | Riccardo Cappato, J. Thomas Bigger, Arthur J. Moss, Alan H. Kadish, Rex Edwards, Benjamin A. Steinberg, Peter J. Kudenchuk, Sana M. Al-Khatib, Daniel B. Mark, Richard C. Steinman, Gillian D Sanders, Alfred P. Hallstrom, Gust H. Bardy, Alfred E. Buxton, Kerry L. Lee, Lurdes Y. T. Inoue, Paul Dorian, JooYoon Han |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Ejection fraction business.industry medicine.medical_treatment Hazard ratio Atrial fibrillation Implantable cardioverter-defibrillator medicine.disease Comorbidity Sudden cardiac death Internal medicine Heart failure medicine Cardiology Cardiology and Cardiovascular Medicine business Multicenter Automatic Defibrillator Implantation Trial |
| Zdroj: | JACC: Heart Failure. 2:623-629 |
| ISSN: | 2213-1779 |
| DOI: | 10.1016/j.jchf.2014.06.007 |
| Popis: | Objectives The aim of this study was to determine if the benefit of implantable cardioverter-defibrillators (ICDs) is modulated by medical comorbidity. Background Primary prevention ICDs improve survival in patients at risk for sudden cardiac death. Their benefit in patients with significant comorbid illness has not been demonstrated. Methods Original, patient-level datasets from MADIT I (Multicenter Automatic Defibrillator Implantation Trial I), MADIT II, DEFINITE (Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation), and SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) were combined. Patients in the combined population (N = 3,348) were assessed with respect to the following comorbidities: smoking, pulmonary disease, diabetes, peripheral vascular disease, atrial fibrillation, ischemic heart disease, and chronic kidney disease. The primary outcome was overall mortality, using the hazard ratio (HR) of time to death for patients receiving an ICD versus no ICD by extent of medical comorbidity, and adjusted for age, sex, race, left ventricular ejection fraction, use of antiarrhythmic drugs, beta-blockers, and angiotensin-converting enzyme inhibitors. Results Overall, 25% of patients (n = 830) had Conclusions Patients with extensive comorbid medical illnesses may experience less benefit from primary prevention ICDs than those with less comorbidity; implantation should be carefully considered in sick patients. Further study of ICDs in medically complex patients is warranted. |
| Databáze: | OpenAIRE |
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