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Association Between Prophylactic Implantable Cardioverter-Defibrillators and Survival in Patients With Left Ventricular Ejection Fraction Between 30% and 35% JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Al-Khatib, S. M., Hellkamp, A. S., Fonarow, G. C., Mark, D. B., Curtis, L. H., Hernandez, A. F., Anstrom, K. J., Peterson, E. D., Sanders, G. D., Al-Khalidi, H. R., Hammill, B. G., Heidenreich, P. A., Hammill, S. C. 2014; 311 (21): 2209-2215

Abstract

Clinical trials of prophylactic implantable cardioverter-defibrillators (ICDs) have included a minority of patients with a left ventricular ejection fraction (LVEF) between 30% and 35%. Because a large number of ICDs in the United States are implanted in such patients, it is important to study survival associated with this therapy.To characterize patients with LVEF between 30% and 35% and compare the survival of those with and without ICDs.Retrospective cohort study of Medicare beneficiaries in the National Cardiovascular Data Registry ICD registry (January 1, 2006, through December 31, 2007) with an LVEF between 30% and 35% who received an ICD during a heart failure hospitalization and similar patients in the Get With The Guidelines-Heart Failure (GWTG-HF) database (January 1, 2005, through December 31, 2009) with no ICD. The analysis was repeated in patients with an LVEF less than 30%. There were 3120 patients with an LVEF between 30% and 35% (816 in matched cohorts) and 4578 with an LVEF less than 30% (2176 in matched cohorts). Propensity score matching and Cox models were applied.The primary outcome was all-cause mortality; data were obtained from Medicare claims through December 31, 2011.There were no significant differences in the baseline characteristics of the matched groups (n?=?408 for both groups). Among patients with an LVEF between 30% and 35%, there were 248 deaths in the ICD Registry group, within a median follow-up of 4.4 years (interquartile range, 2.7-4.9) and 249 deaths in the GWTG HF group, within a median follow-up of 2.9 years (interquartile range, 2.1-4.4). The risk of all-cause mortality in patients with an LVEF between 30% and 35% and an ICD was significantly lower than that in matched patients without an ICD (3-year mortality rates: 51.4% vs 55.0%; hazard ratio, 0.83 [95% CI, 0.69-0.99]; P?=?.04). Presence of an ICD also was associated with better survival in patients with an LVEF less than 30% (3-year mortality rates: 45.0% vs 57.6%; 634 and 660 total deaths; hazard ratio, 0.72 [95% CI, 0.65-0.81]; P?

View details for DOI 10.1001/jama.2014.5310

View details for PubMedID 24893088