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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

Authors
 Chi Keong Ching  ;  Yu-Cheng Hsieh  ;  Yen-Bing Liu  ;  Diego A Rodriguez  ;  Young-Hoon Kim  ;  Boyoung Joung  ;  Balbir Singh  ;  Dejia Huang  ;  Azlan Hussin  ;  Alexandr R Chasnoits  ;  Janet E O'Brien  ;  Jeffrey Cerkvenik  ;  Daniel Lexcen  ;  Brian Van Dorn  ;  Shu Zhang 
Citation
 JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol.32(8) : 2285-2294, 2021-08 
Journal Title
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
ISSN
 1045-3873 
Issue Date
2021-08
MeSH
Cardiac Resynchronization Therapy Devices ; Cardiac Resynchronization Therapy* ; Defibrillators, Implantable* ; Heart Failure* / diagnosis ; Heart Failure* / therapy ; Humans ; Primary Prevention ; Prospective Studies ; Risk Factors ; Treatment Outcome
Keywords
cardiac resynchronization therapy defibrillator ; guideline adherence ; implantable cardioverter-defibrillator ; mortality ; primary prevention ; sudden cardiac death
Abstract
Background: In primary prevention (PP) patients the utilization of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy-defibrillators (CRT-D) remains low in many geographies, despite the proven mortality benefit.

Purpose: The objective of this analysis was to examine the mortality benefit in PP patients by guideline-indicated device type: ICD and CRT-D.

Methods: Improve sudden cardiac arrest was a prospective, nonrandomized, nonblinded 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 nonimplanted patients. Cox proportional hazards methods were used, adjusting for known factors affecting mortality risk.

Results: Among 2618 PP patients followed for a mean of 20.8 ± 10.8 months, 1073 were indicated for a CRT-D, and 1545 were indicated for an ICD. PP CRT-D-indicated patients who received CRT-D therapy had a 58% risk reduction in mortality compared with those without implant (adjusted hazard ratio [HR]: 0.42, 95% confidence interval [CI]: 0.28-0.61, p < .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 = .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.

Trial registration: ClinicalTrials.gov NCT02099721.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/jce.15149
DOI
10.1111/jce.15149
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186874
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