Format

Send to

Choose Destination
J Cardiovasc Electrophysiol. 2017 Nov;28(11):1345-1351. doi: 10.1111/jce.13307. Epub 2017 Aug 23.

Predicting appropriate shocks in patients with heart failure: Patient level meta-analysis from SCD-HeFT and MADIT II.

Author information

1
Duke University Hospital, Durham, NC, USA.
2
Duke Clinical Research Institute, Durham, NC, USA.
3
University of Washington, Seattle, WA, USA.
4
Columbia University, NY, NY, USA.
5
Beth Israel Deaconess Medical Center, Boston, MA, USA.
6
University of Rochester, Rochester, NY, USA.
7
University of Toronto, Toronto, Ontario, Canada.
8
Humanitas University and Humanitas Clinical Research Institute, Milan, Italy.
9
Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA.

Abstract

BACKGROUND:

No precise tools exist to predict appropriate shocks in patients with a primary prevention ICD. We sought to identify characteristics predictive of appropriate shocks in patients with a primary prevention implantable cardioverter defibrillator (ICD).

METHODS:

Using patient-level data from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), we identified patients with any appropriate shock. Clinical and demographic variables were included in a logistic regression model to predict appropriate shocks.

RESULTS:

There were 1,463 patients randomized to an ICD, and 285 (19%) had ≥1 appropriate shock over a median follow-up of 2.59 years. Compared with patients without appropriate ICD shocks, patients who received any appropriate shock tended to have more severe heart failure. In a multiple logistic regression model, predictors of appropriate shocks included NYHA class (NYHA II vs. I: OR 1.65, 95% CI 1.07-2.55; NYHA III vs. I: OR 1.74, 95% CI 1.10-2.76), lower LVEF (per 1% change) (OR 1.04, 95% CI 1.02-1.06), absence of beta-blocker therapy (OR 1.61, 95% CI 1.23-2.12), and single chamber ICD (OR 1.67, 95% CI 1.13-2.45).

CONCLUSION:

In this meta-analysis of patient level data from MADIT-II and SCD-HeFT, higher NYHA class, lower LVEF, no beta-blocker therapy, and single chamber ICD (vs. dual chamber) were significant predictors of appropriate shocks.

KEYWORDS:

implantable cardioverter defibrillator; meta-analysis; primary prevention

PMID:
28744959
PMCID:
PMC5693305
DOI:
10.1111/jce.13307
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center