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Prophylactic ICDs improved survival in patients with less severe HF
Medicare patients hospitalized for HF and with left ventricular ejection fraction between 30% to 35% and less than 30% had a better survival rate at 3 years if they received a prophylactic implantable cardioverter defibrillator, according to new study results.
“Clinical trials of prophylactic ICDs have included a minority of patients with a 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,” Sana M. Al-Khatib, MD, MHS, from Duke Clinical Research Institute, and colleagues wrote.
Researchers conducted a retrospective cohort study utilizing data collected from the National Cardiovascular Data Registry (NCDR) ICD Registry and the American Heart Association Get With the Guidelines-Heart Failure (GWTG-HF) databases. The 533 Medicare patients identified from the NCDR were aged at least 65 years, had an LVEF between 30% and 35%, and underwent implantation of a prophylactic ICD in 2006 or 2007. The 2,972 Medicare patients identified from the GWTG-HF database were also aged 65 years or older, had an LVEF between 30% and 35%, were admitted to the hospital for HF from 2005 to 2009, and did not receive a prophylactic ICD.
The researchers linked patient data from the registries with Medicare Part A inpatient claims. Patients were matched by admission and discharge dates, birthday, sex and hospital, and similar methods were used to replicate the analysis in a sample of HF patients with LVEF <30%.
In total, the analysis included 3,120 patients with an LVEF of 30% to 35% (816 in matched cohorts) and 4,578 with a LVEF of <30% (2,176 in matched cohorts), according to the study.
The primary outcome was all-cause mortality. Among patients with an LVEF between 30% and 35%, 248 patients in the NCDR group died within a median follow-up of 4.4 years and 249 patients in the GWTG-HF group died within a median of 2.9 years, according to the study results.
Patients with an LVEF between 30% and 35% and a prophylactic ICD had a significantly lower risk for all-cause mortality compared with matched patients who did not receive a prophylactic ICD (3-year mortality rate: 51.4% vs. 55%; HR=0.83; 95% CI, 0.69-0.99).
The researchers also found a correlation between presence of a prophylactic ICD and better survival in patients with a LVEF <30% (3-year mortality rate: 45% vs. 57.6%; HR=0.72; 95% CI, 0.65-0.81), according to the study results.
“Using the largest registry of ICD implants in the United States and studying ‘real world’ settings, we showed that the survival of patients with HF and an LVEF between 30% and 35% was significantly better than that of patients with HF and no ICD,” the researchers concluded. “Patients with an LVEF less than 30% and an ICD also had better survival than patients with HF and no ICD.”
The researchers said these data validate guideline recommendations for the prophylactic use of ICDs in appropriate HF patients with an LVEF <35%.
Disclosure: See the full study for the researchers’ relevant financial disclosures.