Format

Send to

Choose Destination
See comment in PubMed Commons below
JAMA. 2014 Jun 4;311(21):2209-15. doi: 10.1001/jama.2014.5310.

Association between prophylactic implantable cardioverter-defibrillators and survival in patients with left ventricular ejection fraction between 30% and 35%.

Author information

  • 1Duke Clinical Research Institute, Department of Medicine, Duke University Medical Center, Durham, North Carolina3Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
  • 2Duke Clinical Research Institute, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
  • 3Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
  • 4Duke Clinical Research Institute, Department of Medicine, Duke University Medical Center, Durham, North Carolina2Center for Clinical and Genetic Economics, Department of Medicine, Duke University Medical Center, Durham, North Carolina4Division of General.
  • 5Stanford University, Palo Alto Veteran's Health Care System, Palo Alto, California.
  • 6Duke Clinical Research Institute, Department of Medicine, Duke University Medical Center, Durham, North Carolina2Center for Clinical and Genetic Economics, Department of Medicine, Duke University Medical Center, Durham, North Carolina7Mayo Clinic, Rochest.

Abstract

IMPORTANCE:

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.

OBJECTIVE:

To characterize patients with LVEF between 30% and 35% and compare the survival of those with and without ICDs.

DESIGN, SETTING, AND PARTICIPANTS:

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.

MAIN OUTCOMES AND MEASURES:

The primary outcome was all-cause mortality; data were obtained from Medicare claims through December 31, 2011.

RESULTS:

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 < .001) (P = .20 for interaction).

CONCLUSIONS AND RELEVANCE:

Among Medicare beneficiaries hospitalized for heart failure and with an LVEF between 30% and 35% and less than 30%, survival at 3 years was better in patients who received a prophylactic ICD than in comparable patients with no ICD. These findings support guideline recommendations to implant prophylactic ICDs in eligible patients with an LVEF of 35% or less.

[PubMed - indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems Icon for PubMed Central
    Loading ...
    Write to the Help Desk