scholarly journals The mortality analysis of primary prevention patients receiving a cardiac resynchronization defibrillator (CRT‐D) or implantable cardioverter defibrillator (ICD) according to guideline indications in the Improve SCA Study.

2021 ◽  
Author(s):  
C.K. Ching ◽  
YC Hsieh ◽  
YB Liu ◽  
DA Rodriquez ◽  
YH Kim ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Resynchronization ◽  
Cardioverter Defibrillator ◽  
Mortality Analysis

scholarly journals The mortality analysis of primary prevention patients receiving a cardiac resynchronization defibrillator (CRT-D) or implantable cardioverter defibrillator (ICD) according to guideline indications in the Improve SCA Study.

2021 ◽  
Author(s):  
Chi Keong Ching ◽  
Yu-Cheng Hsieh ◽  
Yen-Bin Liu ◽  
Diego Rodriguez ◽  
Young-Hoon Kim ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Cardiac Resynchronization Therapy ◽  
Implantable Cardioverter Defibrillator ◽  
Risk Reduction ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Mortality Benefit ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
Device Type

Background: Despite a proven mortality benefit in primary prevention (PP) patients, the utilization of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy-defibrillators (CRT-D) remains low in many geographies. Purpose: The objective of this analysis was to examine the mortality benefit in PP patients by guideline-indicated device type: implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D). Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from regions where ICD utilization is low. PP patient’s CRT-D or ICD eligibility was based upon the 2008 ACC/AHA/HRS and 2006 ESC guidelines. Mortality was assessed according to guideline-indicated device type comparing implanted and non-implanted patients. Cox proportional hazards methods were used, adjusting for known factors affecting mortality risk. Results: Among 2,618 PP patients followed for a mean of 20.8 ± 10.8 months, 1,073 were indicated for a CRT-D, and 1,545 were indicated for an ICD. PP CRT-D-indicated patients who received CRT-D therapy had a 58% risk reduction in mortality compared to those without implant (adjusted HR 0.42, 95% CI: 0.28-0.61, P<0.0001). PP patients with an ICD indication had a 43% risk reduction in mortality with an ICD implant compared with no implant (adjusted HR 0.57, 95% CI: 0.41-0.81, P=0.002). Conclusions: This analysis confirms the mortality benefit of adherence to guideline-indicated implantable defibrillation therapy for PP patients in geographies where ICD therapy was underutilized. These results affirm that medical practice should follow clinical guidelines when choosing therapy for PP patients who meet the respective defibrillator device implant indication.

scholarly journals Comparison of the benefit of primary prevention implantable cardioverter-defibrillator therapy in ischemic versus nonischemic dilated cardiomyopathy

2020 ◽  
Author(s):  
Kun Wang ◽  
Xinyue Xu ◽  
Yu Qi ◽  
Yihai Liu ◽  
Lina Kang ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Dilated Cardiomyopathy ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiovascular Death ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Icd Implantation ◽  
Pump Failure ◽  
Cardioverter Defibrillator ◽  
All Cause Mortality

Introduction: Ischemic cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy (DCM) share common structural alterations with a high mortality from sudden cardiac death (SCD) and pump failure. Implantable cardioverter-defibrillator (ICD) has, since inclusion in international guidelines, been confirmed beneficial and cost-effective for primary prevention of SCD in patients with ICM, while huge debates in non-ischemic heart disease. This study was to compare the primary prophylactic value of ICD therapy in patients with ICM or DCM to identify a subgroup with greater advantage specially. Methods: We conducted a retrospective, single-center study, which enrolled 82 patients with ICM or DCM and guideline indications for primary prophylactic ICD or cardiac resynchronization therapy-defibrillator (CRT-D). Primary end-point was all-cause mortality and secondary outcomes included SCD and cardiovascular death. Results: During a median follow-up of 38.5 months, 78 patients baseline data were analyzable. The primary outcome occurred in 8 patients in ICM group and 5 patients in DCM group (p = 0.012). Cardiovascular death occurred in 5 patients in ICM group and 3 patients in DCM group [hazard ratio (HR) 0.119, 95% confidence interval (CI) 0.016-0.860, P = 0.035]. Resuscitated cardiac arrest or sustained ventricular tachycardia occurred in 4 patients in ICM group and 8 patients in DCM group (HR 0.294, 95% CI 0.040-2.144, P = 0.227). Conclusions: DCM patients with ICD implantation could gain more benefit with a reduction in the risk of all-cause mortality and cardiovascular disease compared with ICM patients, while the occurrence of SCD had no difference in two groups.

Prophylactic implantable cardioverter-defibrillator in the very elderly

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1063-1069 ◽  
Author(s):  
Cyril Zakine ◽  
Rodrigue Garcia ◽  
Kumar Narayanan ◽  
Estelle Gandjbakhch ◽  
Vincent Algalarrondo ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Elderly Population ◽  
The Elderly ◽  
Elderly Group ◽  
Cardiac Resynchronization ◽  
Similar Proportion ◽  
Very Elderly ◽  
Icd Implantation ◽  
Cardioverter Defibrillator

Aims Current guidelines do not propose any age cut-off for the primary prevention implantable cardioverter-defibrillator (ICD). However, the risk/benefit balance in the very elderly population has not been well studied. Methods and results In a multicentre French study assessing patients implanted with an ICD for primary prevention, outcomes among patients aged ≥80 years were compared with <80 years old controls matched for sex and underlying heart disease (ischaemic and dilated cardiomyopathy). A total of 300 ICD recipients were enrolled in this specific analysis, including 150 patients ≥80 years (mean age 81.9 ± 2.0 years; 86.7% males) and 150 controls (mean age 61.8 ± 10.8 years). Among older patients, 92 (75.6%) had no more than one associated comorbidity. Most subjects in the elderly group got an ICD as part of a cardiac resynchronization therapy procedure (74% vs. 46%, P < 0.0001). After a mean follow-up of 3.0 ± 2 years, 53 patients (35%) in the elderly group died, including 38.2% from non cardiovascular causes of death. Similar proportion of patients received ≥1 appropriate therapy (19.4% vs. 21.6%; P = 0.65) in the elderly group and controls, respectively. There was a trend towards more early perioperative events (P = 0.10) in the elderly, with no significant increase in late complications (P = 0.73). Conclusion Primary prevention ICD recipients ≥80 years in the real world had relatively low associated comorbidity. Rates of appropriate therapies and device-related complications were similar, compared with younger subjects. Nevertheless, the inherent limitations in interpreting observational data on this particular competing risk situation call for randomized controlled trials to provide definitive answers. Meanwhile, a careful multidisciplinary evaluation is needed to guide patient selection for ICD implantation in the elderly population.

scholarly journals Remote heart failure management using a multiparameter implantable cardioverter-defibrillator alert: the multicentric RE-HEART registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J De Juan Baguda ◽  
J.J Gavira Gomez ◽  
M Pachon Iglesias ◽  
L Pena Conde ◽  
J.M Rubin Lopez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Implantable Cardioverter Defibrillator ◽  
Median Duration ◽  
Office Visit ◽  
Active Phase ◽  
Cardiac Resynchronization ◽  
Office Visits ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Clinical Events

Abstract Background The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator (ICD)-based sensors into an index for prediction of impending heart failure (HF) decompensation. In patients with ICD and cardiac resynchronization therapy ICD remotely monitored at 13 Spanish centers, we analyzed the association between clinical events and HeartLogic alerts and we described the use of the algorithm for the remote management of HF. Methods The association between clinical events and HeartLogic alerts was studied in the blinded phase (from ICD implantation to alert activation – no clinical actions taken in response to alerts) and in the following active phase (after alert activation – clinicians automatically notified in case of alert). Results We enrolled a total of 215 patients (67±13 years old, 77% male, 53% with ischemic cardiomyopathy) with ICD (19%) or CRT-D (81%). The median duration of the blinded phase was 8 [3–12] months. In this phase, the HeartLogic index crossed the threshold value (set by default to 16) 34 times in 20 patients. HeartLogic alerts were associated with 6 HF hospitalizations and 5 unplanned in-office visits for HF. Five additional HeartLogic threshold crossings were not associated with overt HF events, but occurred at the time of changes in drug therapy or of other clinical events. The rate of unexplained alerts was 0.25 alert-patient/year. The median time spent in alert was longer in the case of HF hospitalizations than of in-office visits (75 [min-max: 30–155] days versus 39 [min-max: 5–105] days). The maximum HeartLogic index value was 38±15 in the case of hospitalizations and 24±7 in that of minor HF events. The median duration of the following active phase was 5 [2–10] months. After HeartLogic activation, 40 alerts were reported in 26 patients. Twenty-seven (68%) alerts were associated with multiple HF- or non-HF related conditions or changes in prescribed HF therapy. Multiple actions were triggered by these alerts: HF hospitalization (4), unscheduled in-office visits (8), diuretics increase (8), change in other cardiovascular drugs (5), device reprogramming (2), atrial fibrillation ablation (1), patient education on therapy adherence (2). The rate of unexplained alerts not followed by any clinical action was 0.13 alert-patient/year. These alerts were managed remotely (device data review and phone contact), except for one alert that generated an unscheduled in-office visit. Conclusions HeartLogic index was frequently associated with HF-related clinical events. The activation of the associated alert allowed to remotely detect relevant clinical conditions and to implement clinical actions. The rate of unexplained alerts was low, and the work required in order to exclude any impending decompensation did not constitute a significant burden for the centers. Funding Acknowledgement Type of funding source: None

scholarly journals Survival After Primary Prevention Implantable Cardioverter-Defibrillator Placement Among Patients With Chronic Kidney Disease

2014 ◽  
Vol 7 (5) ◽  
pp. 793-799 ◽  
Author(s):  
Paul L. Hess ◽  
Anne S. Hellkamp ◽  
Eric D. Peterson ◽  
Gillian D. Sanders ◽  
Hussein R. Al-Khalidi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Primary Prevention ◽  
Kidney Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Cardioverter Defibrillator
Sign in / Sign up

Export Citation Format

Share Document