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ICDs confer reduced short- and long-term mortality in HFrEF
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PARIS — Implantable cardioverter defibrillators were underutilized for primary prevention in patients with HF with reduced ejection fraction despite their ability to reduce short- and long-term all-cause mortality, according to a prospective propensity-score matched analysis presented at the European Society of Cardiology Congress.
“Our results support the current ESC guideline recommendation for primary prevention ICD in HFrEF,” Benedikt Schrage, MD, cardiologist at University Heart Center Hamburg and Karolinska Institute in Solna, Sweden, said during a press conference.
Researchers analyzed data from 16,702 patients (mean age, 73 years; 73% men) from the SwedeHF registry who met criteria from the 2016 ESC HF guidelines on the use of ICDs for the primary prevention of sudden cardiac death, which includes an ejection fraction less than 40%, HF for at least 3 months and NYHA class of II or higher.
“This recommendation is based on trials which were initiated more than 20 years ago and might not represent characteristics and treatments of a contemporary HFrEF population,” Schrage said during the press conference.
The primary outcomes were all-cause mortality at 1 year and 5 years. Secondary outcomes included CV mortality at 1 year and 5 years.
Of the patients who met eligibility, 10% had an ICD. The researchers matched 1,305 patients with ICDs with 1,305 patients who did not receive an ICD.
During a mean follow-up of 2.64 years, ICD use was associated with a reduction in the risk for all-cause mortality within 1 year (HR = 0.73; 95% CI, 0.6-0.9). This was also observed at 5 years (HR = 0.88; 95% CI, 0.78-0.99).
These results were consistent in all subgroups including men vs. women, patients with and without ischemic heart disease, in those who enrolled early vs. later into the SwedeHF registry, patients aged younger vs. older than 75 years and in those with and without cardiac resynchronization therapy.
“We can only speculate that the complications in the general practitioner’s mind does not outweigh the benefit of ICDs,” Schrage said during the Q&A portion of the press conference. “Our message now needs to be that we communicate the association of ICD use with reduced mortality. ... We need to get better in transporting this evidence and this information to doctors.”
This study was simultaneously published in Circulation.
In an accompanying editorial in Circulation, Sana M. Al-Khatib, MD, MHS, professor of medicine at Duke University School of Medicine and member of the Duke Clinical Research Institute, and Fred M. Kusumoto, MD, electrophysiologist and the director of heart rhythm services at Mayo Clinic in Jacksonville, Florida, wrote, “The study by Schrage and colleagues adds to the mounting evidence that ICDs are associated with improved survival in contemporary patients with HFrEF and highlights the need for strategies to improve their utilization.” – by Darlene Dobkowski
References:
Schrage B. Hot Line Session 5. Presented at: European Society of Cardiology Congress; Aug. 31-Sept. 4, 2019; Paris.
Al-Khatib SM, et al. Circulation. 2019;doi:10.1161/CIRCULATIONAHA.119.043354.
Schrage B, et al. Circulation. 2019;doi:10.1161/CIRCULATIONAHA.119.043012.
Disclosures: The study was funded by Boston Scientific. Schrage reports he received funding from the German Research Foundation and speakers’ fees from AstraZeneca. Al-Khatib and Kusumoto report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.