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Implantable Cardioverter-defibrillator Utilization and Its Outcomes in Korea: Data from Korean Acute Heart Failure Registry

 Youngjin Cho  ;  Sang Yeong Cho  ;  Il Young Oh  ;  Ji Hyun Lee  ;  Jin Joo Park  ;  Hae Young Lee  ;  Kye Hun Kim  ;  Byung Su Yoo  ;  Seok Min Kang  ;  Sang Hong Baek  ;  Eun Seok Jeon  ;  Jae Joong Kim  ;  Myeong Chan Cho  ;  Shung Chull Chae  ;  Byung Hee Oh  ;  Dong Ju Choi 
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.35(46) : e397, 2020-11 
Journal Title
Issue Date
Heart Failure ; Implantable Cardioverter-defibrillator
Background: There are sparse data on the utilization rate of implantable cardioverter-defibrillator (ICD) and its beneficial effects in Korean patients with heart failure with reduced left ventricular ejection fraction (LVEF).

Methods: Among 5,625 acute heart failure (AHF) patients from 10 tertiary university hospitals across Korea, 485 patients with reassessed LVEF ≤ 35% at least 3 months after the index admission were enrolled in this study. The ICD implantation during the follow-up was evaluated. Mortality was compared between patients with ICDs and age-, sex-, and follow-up duration matched control patients.

Results: Among 485 patients potentially indicated for an ICD for primary prevention, only 56 patients (11.5%) underwent ICD implantation during the follow-up. Patients with ICD showed a significantly lower all-cause mortality compared with their matched control population: adjusted hazard ratio (HR) (95% confidence interval [CI]) = 0.39 (0.16-0.92), P = 0.032. The mortality rate was still lower in the ICD group after excluding patients with cardiac resynchronization therapy (adjusted HR [95% CI] = 0.09 [0.01-0.63], P = 0.015). According to the subgroup analysis for ischemic heart failure, there was a significantly lower all-cause mortality in the ICD group than in the no-ICD group (HR [95% CI] = 0.20 [0.06-0.72], P = 0.013), with a borderline statistical significance (interaction P = 0.069).

Conclusion: Follow-up data of this large, multicenter registry suggests a significant under-utilization of ICD in Korean heart failure patients with reduced LVEF. Survival analysis implies that previously proven survival benefit of ICD in clinical trials could be extrapolated to Korean patients.

Trial registration: ClinicalTrials.gov Identifier: NCT01389843.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
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