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van der Lingen ALCJ, Verstraelen TE, van Erven L, Meeder JG, Theuns DA, Vernooy K, Wilde AAM, Maass AH, Allaart CP. Assessment of ICD eligibility in non-ischaemic cardiomyopathy patients: a position statement by the Task Force of the Dutch Society of Cardiology. Neth Heart J 2024; 32:190-197. [PMID: 38634993 DOI: 10.1007/s12471-024-01859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 04/19/2024] Open
Abstract
International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional status. We propose refinement of these recommendations in patients with NICM, with careful consideration of additional risk parameters for both arrhythmic and non-arrhythmic death. These additional parameters include late gadolinium enhancement on cardiac magnetic resonance imaging and genetic testing for high-risk genetic variants to further assess arrhythmic risk, and age, comorbidities and sex for assessment of non-arrhythmic mortality risk. Moreover, several risk modifiers should be taken into account, such as concomitant arrhythmias that may affect LVEF (atrial fibrillation, premature ventricular beats) and resynchronisation therapy. Even though currently no valid cut-off values have been established, the proposed approach provides a more careful consideration of risks that may result in withholding ICD implantation in patients with low arrhythmic risk and substantial non-arrhythmic mortality risk.
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Affiliation(s)
- Anne-Lotte C J van der Lingen
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tom E Verstraelen
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joan G Meeder
- Department of Cardiology, VieCuri Medical Centre Noord-Limburg, Venlo, The Netherlands
| | - Dominic A Theuns
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University Medical Centre Groningen, Heart Centre, University of Groningen, Groningen, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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2
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Winsløw U, Elming MB, Thune JJ, Haarbo J, Thornvig Philbert B, Svendsen JH, Pehrson S, Jøns C, Bundgaard H, Køber L, Risum N. Reduced inferior wall longitudinal strain is associated with malignant arrhythmias in non-ischemic heart failure. Pacing Clin Electrophysiol 2023. [PMID: 37120825 DOI: 10.1111/pace.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Reduced systolic myocardial function in the inferior region of the left ventricle has been suggested to be associated with malignant arrhythmias. We tested this hypothesis in patients with non-ischemic heart failure. METHODS Patients with non-ischemic heart failure (left ventricular ejection fraction [LVEF] < 35%) were evaluated by 2D-speckle-tracking echocardiography. The regional longitudinal strain was calculated for each of the six left ventricular walls. The reduced regional function was defined as strain below the median. The outcome was a composite of sudden cardiac death, admission with sustained ventricular arrhythmia, resuscitated cardiac arrest, and appropriate therapy from a primary prophylactic implantable cardioverter defibrillator. Time-to-first-event analysis was performed using a Cox model. RESULTS From two centers, 401 patients were included (median age: 63 years, 72% male) with a median LVEF of 25% (interquartile range [IQR] 20;30), and a median inferior wall strain of -9.0% (-12.5; -5.4). During a median follow-up of 4.0 years, 52 outcomes occurred. After multivariate adjustment for clinical and electrocardiographic parameters, inferior wall strain was independently associated with the outcome (HR 2.50 [1.35; 4.62], p = .003). No independent association was found between the composite outcome and reduced strain in any of the other left ventricular walls, Global Longitudinal Strain (HR 1.66 [0.93; 2.98], p = .09), or LVEF (HR 1.33 [0.75; 2.33], p = .33). CONCLUSIONS Below median strain in the left ventricular inferior region was independently associated with a 2.5-fold increase in the risk of malignant arrhythmias and sudden cardiac death in patients with non-ischemic heart failure.
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Affiliation(s)
- Ulrik Winsløw
- Department of Cardiology, Copenhagen University, Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Marie Bayer Elming
- Department of Cardiology, Zealand University Hospital-Roskilde, Roskilde, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Haarbo
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, Copenhagen University, Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University, Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steen Pehrson
- Department of Cardiology, Copenhagen University, Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University, Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University, Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University, Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University, Hospital-Rigshospitalet, Copenhagen, Denmark
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Itzhaki Ben Zadok O, Nardi Agmon I, Neiman V, Eisen A, Golovchiner G, Bental T, Schamroth-Pravda N, Kadmon E, Goldenberg GR, Erez A, Kornowski R, Barsheshet A. Implantable Cardioverter Defibrillator for the Primary Prevention of Sudden Cardiac Death among Patients With Cancer. Am J Cardiol 2023; 191:32-38. [PMID: 36634547 DOI: 10.1016/j.amjcard.2022.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023]
Abstract
Data are limited regarding the characteristics and outcomes of patients with cancer who are found eligible for primary defibrillator therapy. We performed a single-center retrospective analysis of patients with preexisting cancer diagnoses who become eligible for a primary prevention implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) defibrillator. Multicenter Automatic Defibrillator Implantation Trial-ICD (MADIT-ICD) benefit scores were calculated. The study included 75 cancer patients at a median age of 73 (interquartile range 64, 81) years at heart failure diagnosis. Active cancer was present in 51%. Overall, 55% of the cohort had coronary artery disease and 37% were CRT eligible. We found that 48%, 49%, and 3% of cohorts had low, intermediate, and high MADIT-ICD Benefit scores, respectively. Only 27% of patients underwent primary defibrillator implantation. Using multivariate analysis, indication for CRT and intermediate/high MADIT-ICD Benefit categories were found as independent predictors for implantation (odds ratio 8.42 p <0.001 and odds ratio 3.74 p = 0.040, respectively). During a median follow-up of 5.3 (interquartile range 4.5, 7.2) years, one patient (5%) with a defibrillator had appropriate shock therapy and 2 patients (10%) had bacteremia. Of 13 patients with CRT defibrillator-implants, one patient was admitted for heart failure exacerbation (8%). Using a time-varying covariate model, we did not observe statistically significant differences in the survival of patients with cancer implanted versus those not implanted with primary defibrillators (hazard ratio 0.521, p = 0.127). In conclusion, although primary defibrillator therapy is underutilized in patients with cancer, its relative benefit is limited because of competing risk of nonarrhythmic mortality. These findings highlight the need for personalized cardiologic and oncologic coevaluation.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Inbar Nardi Agmon
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Neiman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gregory Golovchiner
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Bental
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nili Schamroth-Pravda
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Kadmon
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gustavo Ruben Goldenberg
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aharon Erez
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Barsheshet
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Theuns DA, Verstraelen TE, van der Lingen ACJ, Delnoy PP, Allaart CP, van Erven L, Maass AH, Vernooy K, Wilde AAM, Boersma E, Meeder JG. Implantable defibrillator therapy and mortality in patients with non-ischaemic dilated cardiomyopathy : An updated meta-analysis and effect on Dutch clinical practice by the Task Force of the Dutch Society of Cardiology. Neth Heart J 2023; 31:89-99. [PMID: 36066840 PMCID: PMC9950314 DOI: 10.1007/s12471-022-01718-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Primary prophylactic implantable cardioverter-defibrillators (ICDs) in patients with non-ischaemic cardiomyopathy (NICMP) remains controversial. This study sought to assess the benefit of ICD therapy with or without cardiac resynchronisation therapy (CRT) in patients with NICMP. In addition, data were compared with real-world clinical data to perform a risk/benefit analysis. METHODS Relevant randomised clinical trials (RCTs) published in meta-analyses since DANISH, and in PubMed, EMBASE and Cochrane databases from 2016 to 2020 were identified. The benefit of ICD therapy stratified by CRT use was assessed using random effects meta-analysis techniques. RESULTS Six RCTs were included in the meta-analysis. Among patients without CRT, ICD use was associated with a 24% reduction in mortality (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.62-0.93; P = 0.008). In contrast, among patients with CRT, a CRT-defibrillator was not associated with reduced mortality (HR: 0.74, 95% CI 0.47-1.16; P = 0.19). For ICD therapy without CRT, absolute risk reduction at 3‑years follow-up was 3.7% yielding a number needed to treat of 27. CONCLUSION ICD use significantly improved survival among patients with NICMP who are not eligible for CRT. Considering CRT, the addition of defibrillator therapy was not significantly associated with mortality benefit compared with CRT pacemaker.
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Affiliation(s)
- D. A. Theuns
- grid.5645.2000000040459992XDepartment of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - T. E. Verstraelen
- grid.5650.60000000404654431Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - A. C. J. van der Lingen
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - P. P. Delnoy
- grid.452600.50000 0001 0547 5927Isala klinieken, Zwolle, The Netherlands
| | - C. P. Allaart
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - L. van Erven
- grid.10419.3d0000000089452978LUMC, Leiden, The Netherlands
| | - A. H. Maass
- grid.4494.d0000 0000 9558 4598UMCG, Groningen, The Netherlands
| | - K. Vernooy
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - A. A. M. Wilde
- grid.5650.60000000404654431Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - E. Boersma
- grid.5645.2000000040459992XDepartment of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - J. G. Meeder
- grid.416856.80000 0004 0477 5022VieCuri, Venlo, The Netherlands
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Winsløw U, Sakthivel T, Zheng C, Bosselmann H, Haugan K, Bruun N, Larroudé C, Iversen K, Saffi H, Frandsen E, Risum N, Bundgaard H, Jøns C. Targeted potassium levels to decrease arrhythmia burden in high risk patients with cardiovascular diseases (POTCAST): Study protocol for a randomized controlled trial. Am Heart J 2022; 253:59-66. [PMID: 35835265 DOI: 10.1016/j.ahj.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Low plasma potassium (p-K) is associated with increased risk of malignant arrhythmia and observational studies indicate protective effects of p-K in the upper reference level. However, randomized clinical studies are needed to document whether actively increasing p-K to high-normal levels is possible and safe and improves cardiovascular outcomes. OBJECTIVE To investigate if increased p-K reduces the risk of malignant arrhythmia and all-cause death in high-risk patients with a cardiovascular disease treated with an implantable cardioverter defibrillator (ICD) for primary or secondary preventive causes. Secondly, to investigate whether high-normal p-K levels can be safely reached and maintained using already available medications and potassium-rich dietary guidance. METHODS This is a prospective, randomized, and open-labelled study enrolling patient at high-risk of malignant arrhythmias. According to sample size calculations, 1,000 patients will be randomized 1:1 to either an investigational regiment that aims to increase and maintain p-K at high-normal levels (4.5-5.0 mmol/L) or to usual standard of care and followed for an expected four years. The trial will run until a total of 291 events have occurred providing an α = 0.05 and 1-β = 0.80. The composite primary endpoint includes ventricular tachycardia >125 bpm lasting >30 seconds, any appropriate ICD-therapy, and all-cause mortality. At present, 739 patients have been randomized. CONCLUSIONS We present the rationale for the design of the POTCAST trial. The inclusion was initiated 2019 and is expected to be finished 2022. The study will show if easily available treatments to increase p-K may be a new treatment modality to protect against malignant arrythmias.
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Affiliation(s)
- Ulrik Winsløw
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark.
| | - Tharsika Sakthivel
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Chaoqun Zheng
- Department of Cardiology, Zealand University Hospital - Roskilde, Denmark
| | - Helle Bosselmann
- Department of Cardiology, Zealand University Hospital - Roskilde, Denmark
| | - Ketil Haugan
- Department of Cardiology, Zealand University Hospital - Roskilde, Denmark
| | - Niels Bruun
- Department of Cardiology, Zealand University Hospital - Roskilde, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Charlotte Larroudé
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Hillah Saffi
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Emil Frandsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Niels Risum
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark
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Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients. Cardiovasc Diabetol 2022; 21:143. [PMID: 35906611 PMCID: PMC9338523 DOI: 10.1186/s12933-022-01580-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy. Methods We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs. Results Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36–1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56–2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35–2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39–0.79). Conclusion Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01580-y.
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Ajibawo T, Okunowo O, Okunade A. Impact of Comorbidity Burden on Cardiac Implantable Electronic Devices Outcomes. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2022; 16:11795468221108212. [PMID: 35783108 PMCID: PMC9247999 DOI: 10.1177/11795468221108212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Background: There is limited data on the impact of comorbidity burden on clinical
outcomes of patients undergoing cardiac implantable electronic devices
(CIED) implantation. Objectives: Our aim was to assess trends in CIED implantations and explore the
relationship between comorbidity burden and outcomes in patients undergoing
de novo implantations. Methods: Using the National Inpatient Sample database from 2000 to 2014, we identified
adults ⩾18 years undergoing de novo CIED procedures. Comorbidity burden was
assessed by Charlson comorbidity Index (CCI), and patients were classified
into 4 categories based on their CCI scores (CCI = 0, CCI = 1, CCI = 2, CCI
⩾3). Annual implantation trends were evaluated. Logistic regression was
conducted to measure the association between categorized comorbidity burden
and outcomes. Results: A total of 3 103 796 de-novo CIED discharge records were identified from the
NIS database. About 22.4% had a CCI score of 0, 28.2% had a CCI score of 1,
22% had a CCI score of 2, and 27.4 % had a CCI score ⩾3. Annual de-novo CIED
implantations peaked in 2006 and declined steadily from 2010 to 2014.
Compared to CCI 0, CCI ⩾3 was independently associated with increased odds
of in-hospital mortality, bleeding, pericardial, and cardiac complications
(all P < .05). Length of stay and hospital charges
increased with increasing comorbidity burden. Conclusions: CCI is a significant predictor of adverse outcomes after CIED implantation.
Therefore, comorbidity burden needs to be considered in the decision-making
process for CIED implant candidates.
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Affiliation(s)
- Temitope Ajibawo
- Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA
| | - Oluwatimilehin Okunowo
- Data Science & Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adeniyi Okunade
- Department of Medicine, Brookdale University Medical Center, Brooklyn, NY, USA
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8
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Mohamed MO, Van Spall HGC, Morillo C, Wilton SB, Kontopantelis E, Rashid M, Wu P, Patwala A, Mamas MA. The Impact of Charlson Comorbidity Index on De Novo Cardiac Implantable Electronic Device Procedural Outcomes in the United States. Mayo Clin Proc 2022; 97:88-100. [PMID: 34862072 DOI: 10.1016/j.mayocp.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/03/2021] [Accepted: 06/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the utility of Charlson comorbidity index (CCI) as a measure of comorbidity burden to predict procedural outcomes after de novo cardiac implantable electronic device (CIED) implantation. METHODS All de novo CIED implantations in the United States National Inpatient Sample between 2015 and 2018 were retrospectively analyzed, stratified by CCI score (0=no comorbidity burden, 1=mild, 2=moderate, ≥3=severe). Multivariable logistic regression models were performed to examine the association between unit CCI score (scale) and in-hospital outcomes (major adverse cerebrovascular and cardiovascular events [MACCE]: composite of all-cause mortality, acute ischemic stroke, thoracic and cardiac complications, and device-related complications; and MACCE individual components). RESULTS Of 474,475 CIED procedures, the distribution of CCI score was as follows: CCI=0 (17.7%), CCI=1 (21.8%), CCI=2 (18.7%), and CCI=3+ (41.8%). Charlson comorbidity index score was associated with increased odds ratios of MACCE (1.10; 95% CI, 1.09 to 1.11), all-cause mortality (1.23; 95% CI, 1.21 to 1.25), and acute stroke (1.45; 95% CI, 1.44 to 1.46). This finding was consistent across all CIED groups except the cardiac resynchronization therapy groups in which CCI was not associated with increased risk of mortality. A higher CCI score was not associated with increased odds of procedural (thoracic and cardiac) and device-related complications. CONCLUSION In a nationwide cohort of CIED procedures, higher comorbidity burden as measured by CCI score was associated with an increased risk of in-hospital mortality and acute ischemic stroke, but not procedure-related (thoracic and cardiac) or device-related complications. Objective assessment of comorbidity burden is important to risk-stratify patients undergoing CIED implantation for better prognostication of their in-hospital survival.
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Affiliation(s)
- Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Harriette G C Van Spall
- Division of Cardiology, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada; ICES, Hamilton, Canada
| | | | | | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK
| | - Pensee Wu
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK.
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Canepa M, Palmisano P, Dell’Era G, Ziacchi M, Ammendola E, Accogli M, Occhetta E, Biffi M, Nigro G, Ameri P, Stronati G, Porto I, Dello Russo A, Guerra F. Usefulness of the MAGGIC Score in Predicting the Competing Risk of Non-Sudden Death in Heart Failure Patients Receiving an Implantable Cardioverter-Defibrillator: A Sub-Analysis of the OBSERVO-ICD Registry. J Clin Med 2021; 11:jcm11010121. [PMID: 35011862 PMCID: PMC8745772 DOI: 10.3390/jcm11010121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
The role of prognostic risk scores in predicting the competing risk of non-sudden death in heart failure patients with reduced ejection fraction (HFrEF) receiving an implantable cardioverter-defibrillator (ICD) is unclear. To this goal, we evaluated the accuracy and usefulness of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. The present analysis included 1089 HFrEF ICD recipients enrolled in the OBSERVO-ICD registry (NCT02735811). During a median follow-up of 36 months (1st-3rd IQR 25-48 months), 193 patients (17.7%) experienced at least one appropriate ICD therapy, and 133 patients died (12.2%) without experiencing any ICD therapy. The frequency of patients receiving ICD therapies was stable around 17-19% across increasing tertiles of 3-year MAGGIC probability of death, whereas non-sudden mortality increased (6.4% to 9.8% to 20.8%, p < 0.0001). Accuracy of MAGGIC score was 0.60 (95% CI, 0.56-0.64) for the overall outcome, 0.53 (95% CI, 0.49-0.57) for ICD therapies and 0.65 (95% CI, 0.60-0.70) for non-sudden death. In patients with higher 3-year MAGGIC probability of death, the increase in the competing risk of non-sudden death during follow-up was greater than that of receiving an appropriate ICD therapy. Results were unaffected when analysis was limited to ICD shocks only. The MAGGIC risk score proved accurate and useful in predicting the competing risk of non-sudden death in HFrEF ICD recipients. Estimation of mortality risk should be taken into greater consideration at the time of ICD implantation.
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Affiliation(s)
- Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, 16100 Genova, Italy; (M.C.); (P.A.); (I.P.)
- Department of Internal Medicine, University of Genova, 16100 Genova, Italy
| | - Pietro Palmisano
- Division of Cardiology, Cardinale G. Panico Hospital, 73039 Tricase, Italy; (P.P.); (M.A.)
| | - Gabriele Dell’Era
- Division of Cardiology, Hospital Maggiore Della Carità, 28100 Novara, Italy; (G.D.); (E.O.)
| | - Matteo Ziacchi
- Institute of Cardiology, University Hospital Policlinic S. Orsola-Malpighi, 40121 Bologna, Italy; (M.Z.); (M.B.)
| | - Ernesto Ammendola
- Division of Cardiology, Vincenzo Monaldi Hospital, 80100 Naples, Italy; (E.A.); (G.N.)
| | - Michele Accogli
- Division of Cardiology, Cardinale G. Panico Hospital, 73039 Tricase, Italy; (P.P.); (M.A.)
| | - Eraldo Occhetta
- Division of Cardiology, Hospital Maggiore Della Carità, 28100 Novara, Italy; (G.D.); (E.O.)
| | - Mauro Biffi
- Institute of Cardiology, University Hospital Policlinic S. Orsola-Malpighi, 40121 Bologna, Italy; (M.Z.); (M.B.)
| | - Gerardo Nigro
- Division of Cardiology, Vincenzo Monaldi Hospital, 80100 Naples, Italy; (E.A.); (G.N.)
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, 16100 Genova, Italy; (M.C.); (P.A.); (I.P.)
- Department of Internal Medicine, University of Genova, 16100 Genova, Italy
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, 60121 Ancona, Italy; (G.S.); (A.D.R.)
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, 16100 Genova, Italy; (M.C.); (P.A.); (I.P.)
- Department of Internal Medicine, University of Genova, 16100 Genova, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, 60121 Ancona, Italy; (G.S.); (A.D.R.)
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, 60121 Ancona, Italy; (G.S.); (A.D.R.)
- Correspondence: ; Tel.: +39-071-596-5693; Fax: +39-071-596-5624
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10
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Calvi V, Zanotto G, D'Onofrio A, Bisceglia C, Iacopino S, Pignalberi C, Pisanò EC, Solimene F, Giammaria M, Biffi M, Maglia G, Marini M, Senatore G, Pedretti S, Forleo GB, Santobuono VE, Curnis A, Russo AD, Rapacciuolo A, Quartieri F, Bertocchi P, Caravati F, Manzo M, Saporito D, Orsida D, Santamaria M, Bottaro G, Giacopelli D, Gargaro A, Bella PD. One-year mortality after implantable defibrillator implantation: do risk stratification models help improving clinical practice? J Interv Card Electrophysiol 2021; 64:607-619. [PMID: 34709504 DOI: 10.1007/s10840-021-01083-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the available mortality risk stratification models for implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) patients. METHODS We conducted a review of mortality risk stratification models and tested their ability to improve prediction of 1-year survival after implant in a database of patients who received a remotely controlled ICD/CRT-D device during routine care and included in the independent Home Monitoring Expert Alliance registry. RESULTS We identified ten predicting models published in peer-reviewed journals between 2000 and 2021 (Parkash, PACE, MADIT, aCCI, CHA2DS2-VASc quartiles, CIDS, FADES, Sjoblom, AAACC, and MADIT-ICD non-arrhythmic mortality score) that could be tested in our database as based on common demographic, clinical, echocardiographic, electrocardiographic, and laboratory variables. Our cohort included 1,911 patients with left ventricular dysfunction (median age 71, 18.3% female) from sites not using any risk stratification score for systematic patient screening. Patients received an ICD (53.8%) or CRT-D (46.2%) between 2011 and 2017, after standard physician evaluation. There were 56 deaths within 1-year post-implant, with an all-cause mortality rate of 2.9% (95% confidence interval [CI], 2.3-3.8%). Four predicting models (Parkash, MADIT, AAACC, and MADIT-ICD non-arrhythmic mortality score) were significantly associated with increased risk of 1-year mortality with hazard ratios ranging from 3.75 (CI, 1.31-10.7) to 6.53 (CI 1.52-28.0, p ≤ 0.014 for all four). Positive predictive values of 1-year mortality were below 25% for all models. CONCLUSION In our analysis, the models we tested conferred modest incremental predicting power to ordinary screening methods.
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Affiliation(s)
- Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico - V. Via S. Sofia 78, 95123, Catania, Emanuele, Italy.
| | | | | | | | | | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Stefano Pedretti
- Ospedale Sant'Anna, ASST Lariana, San Fermo della Battaglia, CO, Italy
| | | | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | | | | | - Michele Manzo
- Azienda Ospedaliera Universitaria S.Giovanni Di Dio E Ruggi D'Aragona, Salerno, Italy
| | | | | | | | - Giuseppe Bottaro
- Policlinico G. Rodolico, Az. O.U. Policlinico - V. Via S. Sofia 78, 95123, Catania, Emanuele, Italy
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11
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Varma N, Auricchio A, Connolly AT, Boehmer J, Bahu M, Costanzo MR, Leonelli F, Yoo D, Singh J, Nabutovsky Y, Gold M. The cost of non-response to cardiac resynchronization therapy: characterizing heart failure events following cardiac resynchronization therapy. Europace 2021; 23:1586-1595. [PMID: 34198334 DOI: 10.1093/europace/euab123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/28/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study is to quantify healthcare resource utilization among non-responders to cardiac resynchronization therapy (CRT-NR) by heart failure (HF) events and influence of comorbidities. METHODS AND RESULTS The ADVANCE CRT registry (2013-2015) prospectively identified responders/CRT-NRs 6 months post-implant using the clinical composite score. Heart failure event rates and associated cost, both overall and separated for inpatient hospitalizations, office visits, emergency room visits, and observational stays, were quantified. Costs of events were imputed from payments for similar real-world encounters in subjects with CRT-D/P devices in the MarketScan™ commercial and Medicare Supplemental insurance claims databases. Effects of patient demographics and comorbidities on event rates and cost were evaluated. Of 879 US patients (age 69 ± 11 years, 29% female, ischaemic disease 52%), 310 (35%) were CRT-NR. Among CRT-NRs vs. responders, more patients developed HF (41% vs. 11%, P < 0.001), HF event rate was higher (67.0 ± 21.7 vs. 11.4 ± 3.7/100 pt-year, P < 0.001), and HF readmission within 30 days was more common [hazard ratio 7.06, 95% confidence interval (2.1-43.7)]. Inpatient hospitalization was the most common and most expensive event type in CRT-NR. Comorbid HF was increased by diabetes, hypertension, and pulmonary disorders. Over 2 years, compared to CRT responders, each CRT-NR resulted in excess cost of $6388 ($3859-$10 483) to Medicare (P = 0.015) or $10 197 ($6161-$17 394) to private insurances (P = 0.014). CONCLUSION Healthcare expenditures associated with contemporary CRT non-response management are among the highest for any HF patient group. This illustrates an unmet need for interventions to improve HF outcomes and reduce costs among some CRT recipients.
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Affiliation(s)
- Niraj Varma
- Cardiac Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Angelo Auricchio
- Cardiac Electrophysiology, Cardiocentro Ticino, Lugano, Switzerland
| | | | - John Boehmer
- Heart Failure Program, Dept of Cardiology, Penn State Hershey Heart and Vascular Institute, Hershey, PA, USA
| | - Marwan Bahu
- Cardiac Electrophysiology, Biltmore Cardiology, Phoenix, AZ, USA
| | | | - Fabio Leonelli
- Cardiac Electrophysiology, US Department of Veterans Affairs, Tampa, FL, USA
| | - Dale Yoo
- Heart Rhythm Specialists, Dallas, TX, USA
| | - Jagmeet Singh
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Michael Gold
- Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
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12
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Eboh O, Mao Y, Lee E, Okunrintemi V, Derbal O, Maxwell Hill S, Sears SF, Pursell I, Mounsey JP, Burch A. Out of Hospital Sudden Death in a Rural Population: Low Rates of ICD Underutilization Among Decedents. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:980-985. [PMID: 33913184 DOI: 10.1111/pace.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) reduce mortality in patients at risk for life-threatening arrhythmias. Implantation of ICDs in rural or economically disadvantaged populations is suspected to be low. This study examined Out of Hospital Premature Natural Death (OHPND) and electronic medical record (EMR) data to identify rates of non-implantation of ICDs among decedents in eastern North Carolina. METHODS OHPND cases in 2016 were identified using mortality data and matched with EMRs. Those meeting criteria for ICD implantation based on chart review were adjudicated by two electrophysiologists to determine whether they qualified for implantation. Comorbidity burden was established using Charlson's Comorbidity Index (CCI). RESULTS Out of 1316 OHPND cases, 967 (73.4%) had EMR records. Chart review identified 70 (7.2%) potential ICD candidates with a LVEF ≤35 of which 5 (7.1%) did not meet criteria because LVEF subsequently improved. Of the remaining 65 patients, 32 (49.2%) already received an ICD, and 33 patients (50.7%) met criteria but had not received one. Reasons for non-implantation included: limited life expectancy secondary to comorbidities, principally chronic kidney disease (CKD) (N = 11, 17%), physician non-adherence to guidelines (N = 9, 14%), loss to follow-up (N = 7, 11%), patient refusal (N = 5, 8%), and death before commencing medical therapy (N = 1, 2%). Among our cohort of 967 individuals who died unexpectedly, nine (0.9%) patients may have avoided death with an ICD. CONCLUSION This study using decedent data shows low rates of ICD-underutilization in a rural population and emphasizes the role of advanced comorbidities such as CKD in ICD-underutilization.
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Affiliation(s)
- Oghenesuvwe Eboh
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Yuxuan Mao
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Elisabeth Lee
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Victor Okunrintemi
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Ouassim Derbal
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | | | - Samuel F Sears
- Department of Psychology, Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Irion Pursell
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John P Mounsey
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ashley Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina, USA
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13
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Theuns DAMJ, Niazi K, Schaer BA, Sticherling C, Yap SC, Caliskan K. Reassessment of clinical variables in cardiac resynchronization defibrillator patients at the time of first replacement: Death after replacement of CRT (DARC) score. J Cardiovasc Electrophysiol 2021; 32:1687-1694. [PMID: 33825257 PMCID: PMC8251620 DOI: 10.1111/jce.15031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
Introduction Cardiac resynchronization defibrillator (CRT‐D) as primary prevention is known to reduce mortality. At the time of replacement, higher age and comorbidities may attenuate the benefit of implantable cardioverter‐defibrillator (ICD) therapy. The purpose of this study was to evaluate the progression of comorbidities after implantation and their association with mortality following CRT‐D generator replacement. In addition, a risk score was developed to identify patients at high risk for mortality after replacement. Methods and Results We identified patients implanted with a primary prevention CRT‐D (n = 648) who subsequently underwent elective generator replacement (n = 218) from two prospective ICD registries. The cohort consisted of 218 patients (median age: 70 years, male gender: 73%, mean left ventricular ejection fraction [LVEF]: 36 ± 11% at replacement). Median follow‐up after the replacement was 4.2 years during which 64 patients (29%) died and 11 patients (5%) received appropriate ICD shocks. An increase in comorbidities was observed in 77 patients (35%). The 5‐year mortality rate was 41% in patients with ≥2 comorbidities at the time of replacement. A risk score incorporating age, gender, LVEF, atrial fibrillation, anemia, chronic kidney disease, and history of appropriate ICD shocks at time of replacement accurately predicted 5‐year mortality (C‐statistic 0.829). Patients with a risk score of greater than 2.5 had excess mortality at 5‐year postreplacement compared with patients with a risk score less than 1.5 (57% vs. 6%; p < .001). Conclusion A simple risk score accurately predicts 5‐year mortality after replacement in CRT‐D patients, as patients with a risk score of greater than 2.5 are at high risk of dying despite ICD protection.
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Affiliation(s)
| | - Kaijbar Niazi
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Beat A Schaer
- Department of Cardiology, University of Basel Hospital, Basel, Switzerland
| | | | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
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14
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Masini M, Elia E, Vianello PF, Bertero G, Rossi P, Ameri P, Chiarella F, Brunelli C, Porto I, Sartori P, Canepa M. Frequency, predictors and prognostic impact of implantable cardioverter defibrillator shocks in a primary prevention population with heart failure and reduced ejection fraction. J Cardiovasc Med (Hagerstown) 2021; 22:118-125. [PMID: 32941323 DOI: 10.2459/jcm.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The role of the implantable cardioverter defibrillator (ICD) in primary prevention real-world population is debated. We sought to evaluate the incidence, predictors and prognostic impact of ICD shocks in consecutive heart failure patients implanted for primary prevention at our tertiary institution. METHODS AND RESULTS We retrospectively selected a sample of 497 patients (mean age 64.8 years, 82.1% men, average left ventricular ejection fraction, LVEF, 27.1%). At long-term follow-up (median time 70.4 months), total mortality was 40.8%, and 16.5% of patients had received at least one appropriate shock (3.12%/year). Inappropriate shock [odds ratio (OR) 1.93, 95% confidence interval (95% CI) 1.08-3.47; P = 0.027] and length of follow-up (1 year, OR 1.01, 95% CI 1.00-1.01; P = 0.0031) were associated with the occurrence of appropriate shock, whereas atrial fibrillation (OR 2.65, 95% CI 1.55-4.51, P < 0.001), length of follow-up (1-year OR 1.01, 95% CI 1.00-1.01, P < 0.001) and appropriate shock (OR 1.93, 95% CI 1.08-3.47, P = 0.027) were associated with the occurrence of inappropriate shock. Neither appropriate nor inappropriate shock independently increased mortality risk, whereas older age (hazard ratio 1.05; 95% CI 1.04-1.07; P < 0.001), atrial fibrillation (hazard ratio 2.25; 95% CI 1.67-3.02; P < 0.001) and lower LVEF (hazard ratio 0.97; 95% CI 0.94-0.99; P = 0.004) did. CONCLUSION Incidence of shocks in real-world primary prevention ICD recipients might be lower than expected, and the association between ICD shocks and prolongation of survival is not as clear-cut as might be perceived. Further investigations from larger real-world samples are warranted.
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Affiliation(s)
- Marta Masini
- Department of Internal Medicine, University of Genova
| | - Edoardo Elia
- Department of Internal Medicine, University of Genova
| | | | - Giovanni Bertero
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Paolo Rossi
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Francesco Chiarella
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | | | - Italo Porto
- Department of Internal Medicine, University of Genova.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Paolo Sartori
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genova.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
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15
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Theuns DAMJ, Schaer BA, Caliskan K, Hoeks SE, Sticherling C, Yap SC, Alba AC. Application of the heart failure meta-score to predict prognosis in patients with cardiac resynchronization defibrillators. Int J Cardiol 2021; 330:73-79. [PMID: 33516838 DOI: 10.1016/j.ijcard.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Heart Failure (HF) Meta-score may be useful in predicting prognosis in patients with primary prevention cardiac resynchronization defibrillators (CRT-D) considering the competing risk of appropriate defibrillator shock versus mortality. METHODS Data from 648 consecutive patients from two centers were used for the evaluation of the performance of the HF Meta-score. The primary endpoint was mortality and the secondary endpoint was time to first appropriate implantable cardioverter-defibrillator (ICD) shock or death without prior appropriate ICD shock. Fine-Gray model was used for competing risk regression analysis. RESULTS In the entire cohort, 237 patients died over a median follow-up of 5.2 years. Five-year cumulative incidence of mortality ranged from 12% to 53%, for quintiles 1 through 5 of the HF Meta-score, respectively (log-rank P < 0.001). Compared with the lowest quintile, mortality risk was higher in the highest quintile (HR 6.9; 95%CI 3.7-12.8). The HF Meta-score had excellent calibration, accuracy, and good discrimination in predicting mortality (C-statistic 0.76 at 1-year and 0.71 at 5-year). The risk of death without appropriate ICD shock was higher in risk quintile 5 compared to quintile 1 (sub HR 5.8; 95%CI 3.1-11.0, P < 0.001). CONCLUSIONS Our study demonstrated a good ability of the HF Meta-score to predict survival in HF patients treated with CRT-D as primary prevention. The HF Meta-score proved to be useful in identifying a subgroup with a significantly poor prognosis despite a CRT-D.
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Affiliation(s)
| | - Beat A Schaer
- Dept. of Cardiology, University of Basel Hospital, Basel, Switzerland
| | - Kadir Caliskan
- Dept. of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Sanne E Hoeks
- Dept. of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Sing-Chien Yap
- Dept. of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Ana Carolina Alba
- Heart Failure/Transplant program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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16
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Ruwald MH, Ruwald AC, Johansen JB, Gislason G, Lindhardt TB, Nielsen JC, Torp-Pedersen C, Riahi S, Vinther M, Philbert BT. Temporal Incidence of Appropriate and Inappropriate Therapy and Mortality in Secondary Prevention ICD Patients by Cardiac Diagnosis. JACC Clin Electrophysiol 2021; 7:781-792. [PMID: 33516705 DOI: 10.1016/j.jacep.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to estimate the temporal development in rates and incidences of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) therapy and shocks by cardiac diagnosis in a real-world population of patients with secondary prevention ICDs. BACKGROUND Data on cardiac diagnoses and temporal development of ICD therapies in patients with secondary prevention ICDs are limited. METHODS Patients (N = 4,587) with a secondary prevention ICD were identified from the Danish Pacemaker and ICD Register (January 1, 2007, to December 31, 2016) and linked to nationwide administrative registers. The outcome of appropriate and inappropriate ICD therapy and all-cause mortality were analyzed by annual event rates, cumulative incidence plots, and Cox regression models. RESULTS During a mean follow-up of 3.6 ± 2.4 years, 1,362 patients (30%) experienced appropriate ICD therapy (16.8% shocks), and 350 patients (7.6%) experienced inappropriate ICD therapy (4.6% shocks). From 2007 to 2016, there was a significant temporal reduction in both appropriate and inappropriate ICD therapy from 28.2 (95% confidence interval [CI]: 21.6 to 37.0) to 7.9 (95% CI: 6.8 to 9.1) and 10.0 (95% CI: 6.4 to 15.5) to 1.0 (95% CI: 0.7 to 1.5) per 100 person-years (p for trends <0.001). Multivariate Cox regression analyses showed that arrhythmogenic right ventricular cardiomyopathy was associated with the highest probability of appropriate ICD therapy (hazard ratio: 2.45; 95% CI: 1.77 to 3.39; p < 0.0001), whereas patients with hypertrophic cardiomyopathy had the lowest probability (hazard ratio: 0.62; 95% CI: 0.42 to 0.93; p = 0.0196) when compared to patients with ischemic heart disease. CONCLUSIONS In this nationwide real-life cohort of patients with secondary prevention ICDs, we observed a significant temporal decline in delivered appropriate and inappropriate shocks and ICD therapies in the last decade. A large proportion of patients still experienced ICD therapy but with significant differences by cardiac diagnosis.
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Affiliation(s)
- Martin H Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark; National Institute of Public Health, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Tommi B Lindhardt
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | | | - Christian Torp-Pedersen
- Departments of Clinical investigation and Cardiology, North Zealand Hospital, Hillerod, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Vinther
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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17
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Kim J, Choi J, Shin MS, Park JK, An M, Kim SH, Choi N, Lee MO, Heo S. Effect of physical and psychocognitive function and perceived health status on 12-month adverse cardiac events among implantable cardioverter-defibrillator recipients. Heart Lung 2020; 49:530-536. [PMID: 32434703 DOI: 10.1016/j.hrtlng.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Post-implant recovery in patients with implantable cardioverter-defibrillators (ICDs) is often compromised because of reduced physical and psycho-cognitive function and poor health perception, leading to short event-free survival. OBJECTIVES To examine the effects of psychocognitive function, health perception, and ICD-related factors on 12-month cardiac events among ICD patients. METHODS Using a prospective study design, ICD patients underwent baseline assessment and were followed for 12 months to assess cardiac events. RESULTS Cardiac events occurred in 14 patients (18.9%) (N = 74: age, 58 years; primary ICDs, 45.9%). Time after ICD implant (odds ratio [OR] = 1.002; p = .028) and executive function (OR = 1.021; p = .027) were significant predictors of 12-month cardiac events, while other physical and psychological indices were not. CONCLUSIONS Reduced executive function and longer time after implant predicted the events. Healthcare professionals need to assess executive function and provide treatment and support to improve executive function.
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Affiliation(s)
- JinShil Kim
- Gachon University, College of Nursing, Incheon, South Korea
| | - Jiin Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, College of Medicine, Incheon, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Minjeong An
- Chonnam National University, College of Nursing, Gwangju, South Korea
| | - Sun Hwa Kim
- Department of Nursing, Hanyang University Medical Center, Seoul, South Korea.
| | - Nayeon Choi
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Mee Ok Lee
- Gachon University Gil Medical Center, Incheon, South Korea
| | - Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing, Atlanta, USA
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18
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Veltmann C, Winter S, Duncker D, Jungbauer CG, Wäßnig NK, Geller JC, Erath JW, Goeing O, Perings C, Ulbrich M, Roser M, Husser D, Gansera LS, Soezener K, Malur FM, Block M, Fetsch T, Kutyifa V, Klein HU. Protected risk stratification with the wearable cardioverter-defibrillator: results from the WEARIT-II-EUROPE registry. Clin Res Cardiol 2020; 110:102-113. [PMID: 32377784 PMCID: PMC7806570 DOI: 10.1007/s00392-020-01657-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 04/25/2020] [Indexed: 12/22/2022]
Abstract
Background The prospective WEARIT-II-EUROPE registry aimed to assess the value of the wearable cardioverter-defibrillator (WCD) prior to potential ICD implantation in patients with heart failure and reduced ejection fraction considered at risk of sudden arrhythmic death. Methods and results 781 patients (77% men; mean age 59.3 ± 13.4 years) with heart failure and reduced left ventricular ejection fraction (LVEF) were consecutively enrolled. All patients received a WCD. Follow-up time for all patients was 12 months. Mean baseline LVEF was 26.9%. Mean WCD wearing time was 75 ± 47.7 days, mean daily WCD use 20.3 ± 4.6 h. WCD shocks terminated 13 VT/VF events in ten patients (1.3%). Two patients died during WCD prescription of non-arrhythmic cause. Mean LVEF increased from 26.9 to 36.3% at the end of WCD prescription (p < 0.01). After WCD use, ICDs were implanted in only 289 patients (37%). Forty patients (5.1%) died during follow-up. Five patients (1.7%) died with ICDs implanted, 33 patients (7%) had no ICD (no information on ICD in two patients). The majority of patients (75%) with the follow-up of 12 months after WCD prescription died from heart failure (15 patients) and non-cardiac death (15 patients). Only three patients (7%) died suddenly. In seven patients, the cause of death remained unknown. Conclusions Mortality after WCD prescription was mainly driven by heart failure and non-cardiovascular death. In patients with HFrEF and a potential risk of sudden arrhythmic death, WCD protected observation of LVEF progression and appraisal of competing risks of potential non-arrhythmic death may enable improved selection for beneficial ICD implantation. Graphic abstract ![]()
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Affiliation(s)
- Christian Veltmann
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | | - David Duncker
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | | | - J Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany.,Otto-Von-Guericke University School of Medicine, Magdeburg, Germany
| | - Julia W Erath
- Abteilung für Klinische Elektrophysiologie, Medizinische Klinik III, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | | | | | | | - Mattias Roser
- Klinikum Benjamin Franklin, Charité Berlin, Berlin, Germany
| | - Daniela Husser
- Klinik für Kardiologie, Herzzentrum Leipzig, Leipzig, Germany
| | - Laura S Gansera
- Klinik für Kardiologie, Klinikum Augsburg, Augsburg, Germany
| | | | | | - Michael Block
- Klinik für Kardiologie, Klinikum Augustinum München, Munich, Germany
| | - Thomas Fetsch
- CRI-Clinical Research Institute München, Munich, Germany
| | - Valentina Kutyifa
- Medical Center, Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Helmut U Klein
- Medical Center, Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
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19
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Rosano GMC, Seferović PM. Physiological monitoring in the complex multi-morbid heart failure patient - Introduction. Eur Heart J Suppl 2020; 21:M1-M4. [PMID: 31908606 PMCID: PMC6937512 DOI: 10.1093/eurheartj/suz229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Repeated physiological monitoring of comorbidities in heart failure (HF) is pivotal. This document introduces the main challenges related to physiological monitoring in the complex multimorbid HF patient, arising during an ESC consensus meeting on this topic.
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Affiliation(s)
- Giuseppe M C Rosano
- Department of Medical Sciences, IRCCS San Raffaele IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Roma, Italy
| | - Petar M Seferović
- Faculty of Medicine, Belgrade University, Studentski trg 1, 11000 Belgrade, Serbia
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20
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Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights in heart failure. ESC Heart Fail 2019; 6:1105-1127. [PMID: 31997538 PMCID: PMC6989277 DOI: 10.1002/ehf2.12555] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in recent studies in patients hospitalized for acute HF. More recently, dapagliflozin and prevention of adverse-outcomes in DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HF research are summarized and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Marianna Adamo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Carlo Mario Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
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21
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Lüker J, Kuhr K, Sultan A, Nölker G, Omran H, Willems S, Andrié R, Schrickel JW, Winter S, Vollmann D, Tilz RR, Jobs A, Heeger CH, Metzner A, Meyer S, Mischke K, Napp A, Fahrig A, Steinhauser S, Brachmann J, Baldus S, Mahajan R, Sanders P, Steven D. Internal Versus External Electrical Cardioversion of Atrial Arrhythmia in Patients With Implantable Cardioverter-Defibrillator: A Randomized Clinical Trial. Circulation 2019; 140:1061-1069. [PMID: 31466479 DOI: 10.1161/circulationaha.119.041320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial arrhythmias are common in patients with implantable cardioverter-defibrillator (ICD). External shocks and internal cardioversion through commanded ICD shock for electrical cardioversion are used for rhythm-control. However, there is a paucity of data on efficacy of external versus internal cardioversion and on the risk of lead and device malfunction. We hypothesized that external cardioversion is noninferior to internal cardioversion for safety, and superior for successful restoration of sinus rhythm. METHODS Consecutive patients with ICD undergoing elective cardioversion for atrial arrhythmias at 13 centers were randomized in 1:1 fashion to either internal or external cardioversion. The primary safety end point was a composite of surrogate events of lead or device malfunction. Conversion of atrial arrhythmia to sinus rhythm was the primary efficacy end point. Myocardial damage was studied by measuring troponin release in both groups. RESULTS N=230 patients were randomized. Shock efficacy was 93% in the external cardioversion group and 65% in the internal cardioversion group (P<0.001). Clinically relevant adverse events caused by external or internal cardioversion were not observed. Three cases of pre-existing silent lead malfunction were unmasked by internal shock, resulting in lead failure. Troponin release did not differ between groups. CONCLUSIONS This is the first randomized trial on external vs internal cardioversion in patients with ICDs. External cardioversion was superior for the restoration of sinus rhythm. The unmasking of silent lead malfunction in the internal cardioversion group suggests that an internal shock attempt may be reasonable in selected ICD patients presenting for electrical cardioversion. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03247738.
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Affiliation(s)
- Jakob Lüker
- University of Cologne, University Hospital Cologne, Department of Electrophysiology (J.L., A.S., D.S.), Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics and Computational Biology (IMSB) (K.K., S.S.), Germany
| | - Arian Sultan
- University of Cologne, University Hospital Cologne, Department of Electrophysiology (J.L., A.S., D.S.), Germany
| | - Georg Nölker
- Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Clinic for Electrophysiology, Bad Oeynhausen, Germany (G.N., H.O.)
| | - Hazem Omran
- Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Clinic for Electrophysiology, Bad Oeynhausen, Germany (G.N., H.O.)
| | - Stephan Willems
- Department of Electrophysiology, University Heart Center, Hamburg, Germany (S.W.)
| | - René Andrié
- Department of Internal Medicine II, University Hospital Bonn, Germany (R.A., J.W.S.)
| | - Jan W Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Germany (R.A., J.W.S.)
| | | | | | - Roland R Tilz
- Department of Cardiology, University Hospital Lübeck, Germany (R.R.T., A.J., C.H.H.)
| | - Alexander Jobs
- Department of Cardiology, University Hospital Lübeck, Germany (R.R.T., A.J., C.H.H.).,Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany (A.J.)
| | - Christian-H Heeger
- Department of Cardiology, University Hospital Lübeck, Germany (R.R.T., A.J., C.H.H.)
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (A.M.)
| | - Sven Meyer
- Department of Cardiology, Heart Center Oldenburg, European Medical School Oldenburg-Groningen, Germany (S.M.)
| | - Karl Mischke
- Medical Clinic I, Leopoldina Hospital, Schweinfurt, Germany (K.M.)
| | - Andreas Napp
- Department of Internal Medicine I, RWTH Aachen University Hospital, Germany (A.N.)
| | | | - Susanne Steinhauser
- Institute of Medical Statistics and Computational Biology (IMSB) (K.K., S.S.), Germany
| | | | | | - Rajiv Mahajan
- Center for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Australia (R.M., P.S.)
| | - Prashanthan Sanders
- Center for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Australia (R.M., P.S.)
| | - Daniel Steven
- University of Cologne, University Hospital Cologne, Department of Electrophysiology (J.L., A.S., D.S.), Germany
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22
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Elming MB, Thøgersen AM, Videbæk L, Bruun NE, Eiskjær H, Haarbo J, Egstrup K, Gustafsson F, Hastrup Svendsen J, Høfsten DE, Pehrson S, Nielsen JC, Køber L, Thune JJ. Duration of Heart Failure and Effect of Defibrillator Implantation in Patients With Nonischemic Systolic Heart Failure. Circ Heart Fail 2019; 12:e006022. [PMID: 31500444 DOI: 10.1161/circheartfailure.119.006022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with nonischemic systolic heart failure (HF) have increased risk of sudden cardiac death (SCD) and death from progressive pump failure. Whether the risk of SCD changes over time is unknown. We seek here to investigate the relation between duration of HF, mode of death, and effect of implantable cardioverter-defibrillator implantation. METHODS AND RESULTS We examined the risk of all-cause death and SCD according to the duration of HF among patients with nonischemic systolic HF enrolled in the DANISH (Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality). In all, 1116 patients were included. Patients were divided according to quartiles of HF duration (≤8, 9≤18, 19≤65, and ≥66 months). Patients with the longest duration of HF were older, more often men, had more comorbidity, and more often received a cardiac resynchronization therapy device. Doubling of HF duration was an independent predictor of both all-cause mortality (hazard ratio [HR], 1.27; 95% CI, 1.17-1.38; P<0.0001), and SCD (HR, 1.29; 95% CI, 1.11-1.50; P=0.0007). The proportion of deaths caused by SCD was not different between HF quartiles (P=0.91), and the effect of implantable cardioverter-defibrillator implantation on all-cause mortality was not modified by the duration of HF (P=0.59). CONCLUSIONS Duration of HF predicted both all-cause mortality and risk of SCD independently of other risk indicators. However, the proportion of death caused by SCD did not change with longer duration of HF, and the effect of implantable cardioverter-defibrillator was not modified by the duration of HF. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945.
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Affiliation(s)
- Marie Bayer Elming
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark.,Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark
| | - Anna M Thøgersen
- Department of Cardiology (A.M.T.), Aalborg University Hospital, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Denmark (L.V.)
| | - Niels E Bruun
- Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark.,Clinical Institute (N.E.B.), Aalborg University Hospital, Denmark.,Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (N.E.B.)
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark (H.E., J.C.N.)
| | - Jens Haarbo
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H.)
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.)
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark.,Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark.,Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark
| | - Dan E Høfsten
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark
| | - Steen Pehrson
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Denmark (H.E., J.C.N.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark.,Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark
| | - Jens Jakob Thune
- Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark.,Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
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23
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Amin MM, Witt CM, Waks JW, Mehta RA, Friedman PA, Kramer DB, Buxton AE, Mulpuru SK, Hodge DO, Frey RJ, Frederick NK, Cha YM, Brenes-Salazar J, Madhavan M. Association between the Charlson comorbidity index and outcomes after implantable cardioverter defibrillator generator replacement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1236-1242. [PMID: 31355952 DOI: 10.1111/pace.13762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/08/2019] [Accepted: 07/18/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recipients of implantable cardioverter defibrillator (ICD) generator replacement with multiple medical comorbidities may be at higher risk of adverse outcomes that attenuate the benefit of ICD replacement. The aim of this investigation was to study the association between the Charlson comorbidity index (CCI) and outcomes after ICD generator replacement. METHODS All patients undergoing first ICD generator replacement at Mayo Clinic, Rochester and Beth Israel Deaconess Medical Center, Boston between 2001 and 2011 were identified. Outcomes included: (a) all-cause mortality, (b) appropriate ICD therapy, and (c) death prior to appropriate therapy. Multivariable Cox regression analysis was performed to assess association between CCI and outcomes. RESULTS We identified 1421 patients with mean age of 69.6 ± 12.1 years, 81% male and median (range) CCI of 3 (0-18). During a mean follow-up of 3.9 ± 3 years, 52% of patients died, 30.6% experienced an appropriate therapy, and 23.6% died without experiencing an appropriate therapy. In multivariable analysis, higher CCI score was associated with increased all-cause mortality (Hazard ratio, HR 1.10 [1.06-1.13] per 1 point increase in CCI, P < .001), death without prior appropriate therapy (HR 1.11 [1.07-1.15], P < .0001), but not associated with appropriate therapy (HR 1.01 [0.97-1.05], P = .53). Patients with CCI ≥5 had an annual risk of death of 12.2% compared to 8.7% annual rate of appropriate therapy. CONCLUSIONS CCI is predictive of mortality following ICD generator replacement. The benefit of ICD replacement in patients with CCI score ≥5 should be investigated in prospective studies.
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Affiliation(s)
- Mustapha M Amin
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Chance M Witt
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jonathan W Waks
- Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ramila A Mehta
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Daniel B Kramer
- Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Alfred E Buxton
- Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Rebecca J Frey
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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24
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Ruwald AC, Gislason GH, Vinther M, Johansen JB, Nielsen JC, Philbert BT, Torp-Pedersen C, Riahi S, Jøns C. Importance of beta-blocker dose in prevention of ventricular tachyarrhythmias, heart failure hospitalizations, and death in primary prevention implantable cardioverter-defibrillator recipients: a Danish nationwide cohort study. Europace 2019; 20:f217-f224. [PMID: 29684191 DOI: 10.1093/europace/euy077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/20/2018] [Indexed: 12/28/2022] Open
Abstract
Aims There is a paucity of studies investigating a dose-dependent association between beta-blocker therapy and risk of outcome. In a nationwide cohort of primary prevention implantable cardioverter-defibrillator (ICD) patients, we aimed to investigate the dose-dependent association between beta-blocker therapy and risk of ventricular tachyarrhythmias (VT/VF), heart failure (HF) hospitalizations, and death. Methods and results Information on ICD implantation, endpoints, comorbidities, beta-blocker usage, type, and dose were obtained through Danish nationwide registers. The two major beta-blockers carvedilol and metoprolol were examined in three dose levels; low (metoprolol ≤ 25 mg; carvedilol ≤ 12.5 mg), intermediate (metoprolol 26-199 mg; carvedilol 12.6-49.9 mg), and high (metoprolol ≥ 200 mg; carvedilol ≥ 50 mg). Time to events was investigated utilizing multivariate Cox models with beta-blocker as a time-dependent variable. From 2007 to 2012, 2935 first-time ICD devices were implanted. During follow-up, 399 patients experienced VT/VF, 728 HF hospitalizations and 361 died. As compared with patients not on beta-blockers, low, intermediate, and high dose had significantly reduced risk of HF hospitalizations {hazard ratio (HR) = 0.68 [0.54-0.87], P = 0.002; HR = 0.53 [0.42-0.66], P < 0.001; HR = 0.43 [0.34-0.54], P < 0.001} and death (HR = 0.47 [0.35-0.64], P < 0.001; HR = 0.29 [0.22-0.39], P = 0.001; HR = 0.24 [0.18-0.33], P < 0.001). For the endpoint of VT/VF, only intermediate and high dose beta-blocker was associated with significantly reduced risk (HR = 0.58 [0.43-0.79], P < 0.001; HR = 0.53 [0.39-0.72], P < 0.001). No significant difference was found between comparable doses of carvedilol and metoprolol on any endpoint (P = 0.06-0.94). Conclusion In primary prevention ICD patients, beta-blocker therapy was associated with significantly reduced risk of all endpoints, as compared with patients not on beta-blocker, with the suggestion of a dose-dependent effect. No detectable difference was found between comparable doses of carvedilol and metoprolol.
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Affiliation(s)
- A C Ruwald
- Department of Medicine, Sjaellands University Hospital, Sygehusvej 10, Roskilde, Denmark.,Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28, Hellerup, Denmark
| | - G H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28, Hellerup, Denmark.,National Institute of Public Health, Øster Farimagsgade 5 A, Copenhagen, Denmark.,Department of Cardiology, University of Southern Denmark, Sdr. Boulevard 29, Odense, Denmark.,The Danish Heart Foundation, Vognmagergade 7, 3. sal, Copenhagen, Denmark
| | - M Vinther
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28, Hellerup, Denmark
| | - J B Johansen
- Department of Cardiology, Odense University Hospital, Kløvervænget 47, Odense, Denmark
| | - J C Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - B T Philbert
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - C Torp-Pedersen
- Institute of Health, Science and Technology, Aalborg University, Niels Jernes Vej 10, Aalborg and Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - S Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - C Jøns
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
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25
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Krieger K, Lenz C. [Continuation of ICD treatment at the time of device exchange without adequate treatment?]. Herzschrittmacherther Elektrophysiol 2019; 30:191-196. [PMID: 31001686 DOI: 10.1007/s00399-019-0621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Due to improved treatment of heart failure, patients are older and have more comorbidities at the time of an elective device exchange. This leads to higher rates of complications and represents an opportunity for re-evaluation of the implantable cardioverter defibrillator (ICD) treatment. OBJECTIVE This article reviews the current literature regarding the indications for continued ICD therapy and device exchange in patients who have never received adequate treatment through the ICD. MATERIAL AND METHODS Patients with primarily prophylactic indications, who have not received adequate treatment and have shown significant improvement in the left ventricular ejection fraction (LVEF) >35%, have a significantly lower risk of ventricular arrythmia (VA) after device exchange. Although further ventricular events can occur in these patients, the continuation of ICD treatment should be individually discussed in cases of high age and increased comorbidities. In female patients with a non-ischemic cardiac myopathy and an almost normalized LVEF, mostly during cardiac resynchronization therapy (CRT), a discontinuation of ICD treatment or downgrading to CRT with pacemaker (CRT-P) treatment should be discussed. CONCLUSION At the time of an elective device exchange for primarily prophylactic indications, the possibility to discontinue ICD treatment can be discussed with patients who have not experienced adequate treatment. Additional factors, such as LVEF, age, sex and comorbidities of the patient should be taken into consideration in order to make an individualized decision. As prospective randomized studies are lacking, it is not possible to give generally valid recommendations.
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Affiliation(s)
- Konstantin Krieger
- Klinik für Innere Medizin und Kardiologie, Unfallkrankenhaus Berlin, Warenerstraße 7, 12683, Berlin, Deutschland.
| | - Corinna Lenz
- Klinik für Innere Medizin und Kardiologie, Unfallkrankenhaus Berlin, Warenerstraße 7, 12683, Berlin, Deutschland.
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Ruwald MH, Ruwald AC, Johansen JB, Gislason G, Nielsen JC, Philbert B, Riahi S, Vinther M, Lindhardt TB. Incidence of appropriate implantable cardioverter-defibrillator therapy and mortality after implantable cardioverter-defibrillator generator replacement: results from a real-world nationwide cohort. Europace 2019; 21:1211-1219. [DOI: 10.1093/europace/euz121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The safety of omitting implantable cardioverter-defibrillator (ICD) generator replacement in patients with no prior appropriate therapy, comorbid conditions, and advanced age is unclear. The aim was to investigate incidence of appropriate ICD therapy after generator replacement.
Methods and results
We identified patients implanted with a primary prevention ICD (n = 4630) from 2007 to 2016, who subsequently underwent an elective ICD generator replacement (n = 670) from the Danish Pacemaker and ICD Register. The data were linked to other databases and evaluated the outcomes of appropriate therapy and death. Predictors of ICD therapy were identified using multivariate Cox regression analyses. A total of 670 patients underwent elective ICD generator replacement. Of these, 197 (29.4%) patients had experienced appropriate therapy in their 1st generator period. During follow-up of 2.0 ± 1.6 years, 95 (14.2%) patients experienced appropriate therapy. Predictors of appropriate therapy in 2nd generator period was low initial left ventricular ejection fraction (≤25%) [hazard ratio (HR) 1.87, confidence interval (CI) 1.13–1.95] and appropriate therapy in 1st generator period (HR 3.95, CI 2.57–6.06). For patients with appropriate therapy in 1st generator period, 4-year incidence of appropriate therapy was 50.6% vs. 16.4% in those without (P < 0.001). Among patients >80 years with no prior appropriate therapy 8.8% of patients experienced appropriate therapy after replacement. Comorbidity burden and advanced age were associated with reduced device utilization after replacement and a high competing risk of death without preceding appropriate therapy.
Conclusion
A significant residual risk of appropriate therapy in the 2nd generator was present even among patients with advanced age and with a full prior generator period without any appropriate ICD events.
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Affiliation(s)
- Martin H Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
- National Institute of Public Health, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Berit Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Vinther
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Tommi B Lindhardt
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
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Sciatti E, Senni M, Lombardi CM, Gori M, Metra M. Sacubitril/valsartan: from a large clinical trial to clinical practice. J Cardiovasc Med (Hagerstown) 2019; 19:473-479. [PMID: 29917003 DOI: 10.2459/jcm.0000000000000687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
: The Prospective Comparison of Angiotensin Receptor Antagonist and Neprilysin Inhibitor with Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial (PARADIGM-HF) has shown a reduction in the risk of death and heart failure hospitalizations with sacubitril/valsartan, compared with enalapril, in patients with heart failure and reduced ejection fraction. Guidelines now recommend the substitution of angiotensin-converting enzyme inhibitors or AT1 blockers with sacubitril/valsartan in patients with heart failure and reduced ejection fraction. The aim of this review is to discuss factors that may have an impact on the implementation of these guidelines into clinical practice. The main limitation is that, based on the inclusion criteria of PARADIGM-HF, sacubitril/valsartan is not indicated in patients with heart failure and preserved ejection fraction, although they may be the majority of the patients with heart failure. The trial enrolled ambulatory patients and thus start of sacubitril/valsartan is not indicated in those hospitalized for heart failure. A drug's tolerability may be limited by hypotension with, however, a lower rate of renal dysfunction, compared with enalapril. The cost of the new treatment is also an issue. Similarly to what occurred when other neurohormonal antagonists have been introduced in clinical practice, increased awareness of poor heart failure outcomes and better patients' management programs may be of utmost importance for the implementation of this new agent.
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Affiliation(s)
- Edoardo Sciatti
- Cardiology, Department of medical and surgical specialties, radiological sciences and public health, University and ASST Spedali Civili, Brescia
| | - Michele Senni
- Cardiovascular Department, Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Carlo M Lombardi
- Cardiology, Department of medical and surgical specialties, radiological sciences and public health, University and ASST Spedali Civili, Brescia
| | - Mauro Gori
- Cardiovascular Department, Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Metra
- Cardiology, Department of medical and surgical specialties, radiological sciences and public health, University and ASST Spedali Civili, Brescia
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Kristensen SL. Individualizing surgical revascularization in patients with ischaemic heart failure - a further dive into STICHES. Eur J Heart Fail 2019; 21:382-384. [PMID: 30773783 DOI: 10.1002/ejhf.1426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 12/25/2018] [Accepted: 12/27/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Søren L Kristensen
- Deparment of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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Christensen AM, Bjerre J, Schou M, Jons C, Vinther M, Gislason GH, Johansen JB, Nielsen JC, Petersen HH, Riahi S, Ruwald AC. Clinical outcome in patients with implantable cardioverter-defibrillator and cancer: a nationwide study. Europace 2018; 21:465-474. [DOI: 10.1093/europace/euy268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne M Christensen
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Jenny Bjerre
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Christian Jons
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Michael Vinther
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- National Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, University of Southern Denmark, Odense, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
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Bjerre J, Rosenkranz SH, Christensen AM, Schou M, Jøns C, Gislason G, Ruwald AC. Driving following defibrillator implantation: development and pilot results from a nationwide questionnaire. BMC Cardiovasc Disord 2018; 18:212. [PMID: 30458722 PMCID: PMC6245910 DOI: 10.1186/s12872-018-0949-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) implantation is associated with driving restrictions which may have profound effects on the patient's life. However, there is limited patient-reported data on the information given about driving restrictions, the adherence to the restrictions, the incidence of arrhythmic symptoms while driving, and the driving restrictions' effect on ICD patients' daily life and quality of life factors. A specific questionnaire was designed to investigate these objectives, intended for use in a nationwide ICD cohort. METHODS The conceptual framework based on literature review and expert opinion was refined in qualitative semi-structured focus group interviews with ten ICD patients. Content validity was pursued through pre-testing, including expert review and 28 cognitive interviews with patients at all ICD implanting centres in Denmark. Finally, the Danish Pacemaker and ICD registry was used to randomly select 50 ICD patients with a first-time implantation between January 1, 2013 and November 30, 2016 for pilot testing, followed by a test-retest on 25 respondents. Test-retest agreement was assessed using kappa statistics or intraclass correlation coefficients. RESULTS The pilot test achieved a response rate of 78%, whereof the majority were web-based (69%). Only 49% stated they had been informed about any driving restrictions after ICD implantation, whereas the number was 75% after appropriate ICD shock. Among respondents, 95% had resumed private driving, ranging from 1 to 90 days after ICD implantation. In those informed of a significant (≥ 1 month) driving ban, 55% stated the driving restrictions had impeded with daily life, especially due to limitations in maintaining employment or getting to/from work and 25% admitted they had knowingly been driving during the restricted period. There were six episodes of dizziness or palpitations not necessitating stopping the vehicle. Test-retest demonstrated good agreement of questionnaire items, with 69% of Kappa coefficients above 0.60. CONCLUSIONS We have developed a comprehensive questionnaire on ICD patients' perspective on driving. Pre-testing and pilot testing demonstrated good content validity, feasible data collection methods, and a robust response rate. Thus, we believe the final questionnaire, distributed to almost 4000 ICD patients, will capture essential evidence to help inform driving guidelines in this population.
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Affiliation(s)
- Jenny Bjerre
- Department of Cardiology, Cardiovascular Research, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark.
| | - Simone Hofman Rosenkranz
- Research and Test Center for Health Technologies, Copenhagen University Hospital, Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Anne Mielke Christensen
- Department of Cardiology, Cardiovascular Research, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet-Glostrup, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet-Glostrup, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Cardiovascular Research, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Cardiovascular Research, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark.,Department of Medicine, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
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Weidner K, Behnes M, Schupp T, Rusnak J, Reiser L, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, Hoppner J, El-Battrawy I, Mashayekhi K, Weiß C, Borggrefe M, Akin I. Type 2 diabetes is independently associated with all-cause mortality secondary to ventricular tachyarrhythmias. Cardiovasc Diabetol 2018; 17:125. [PMID: 30200967 PMCID: PMC6130079 DOI: 10.1186/s12933-018-0768-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/25/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The study sought to assess the prognostic impact of type 2 diabetes in patients presenting with ventricular tachyarrhythmias on admission. BACKGROUND Data regarding the prognostic outcome of diabetics presenting with ventricular tachyarrhythmias is limited. METHODS A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Patients with type 2 diabetes (diabetics) were compared to non-diabetics applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic endpoint of long-term all-cause mortality at 2 years. Secondary prognostic endpoints were cardiac death at 24 h, in-hospital death at index, all-cause mortality at 30 days, all-cause mortality in patients surviving index hospitalization at 2 years (i.e. "after discharge") and rehospitalization due to recurrent ventricular tachyarrhythmias at 2 years. RESULTS In 2411 unmatched high-risk patients with ventricular tachyarrhythmias, diabetes was present in 25% compared to non-diabetics (75%). Rates of VT (57% vs. 56%) and VF (43% vs. 44%) were comparable in both groups. Multivariable Cox regression models revealed diabetics associated with the primary endpoint of long-term all-cause mortality at 2 years (HR = 1.513; p = 0.001), which was still proven after propensity score matching (46% vs. 33%, log rank p = 0.001; HR = 1.525; p = 0.001). The rates of secondary endpoints were higher for in-hospital death at index, all-cause mortality at 30 days, as well as after discharge, but not for cardiac death at 24 h or rehospitalization due to recurrent ventricular tachyarrhythmias. CONCLUSION Presence of type 2 diabetes is independently associated with an increase of all-cause mortality in patients presenting with ventricular tachyarrhythmias on admission.
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Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jorge Hoppner
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Heidelberg, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Rogstad TL, Powell AC, Song Y, Cordier T, Price SE, Long JW, Deshmukh UU, Simmons JD. Determinants of outcomes following outpatient placement of implantable cardioverter defibrillators in a Medicare Advantage population. Clin Cardiol 2018; 41:1130-1135. [PMID: 30091205 DOI: 10.1002/clc.23041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Recipients of ICD are likely to have several risk factors that could interfere with successful use of implantable cardioverter defibrillators (ICDs). HYPOTHESIS Age, sex, and factors indicated in claims are associated with one-year mortality and complications after ICD placement. METHODS Adult Medicare Advantage patients who underwent outpatient ICD implantation from January 2014 to September 2015 were included. Age, sex, Charlson Comorbidity Index (CCI), prior year hospitalization and emergency department (ED) visit, diabetes, heart failure, ischemic heart disease, and indicators of the need for pacing were evaluated as risk factors. Mortality and device-related complications (lead and nonlead) were assessed at one-year post-procedure using Kaplan-Meier and Cox Proportional Hazard analysis. RESULTS Among 8450 patients who underwent implantation, 1-year event-free survival was 80.1%, based on an overall composite measure of complications and mortality. Adjusted survival analysis showed that age ≥ 65, male sex, incremental increase in CCI, heart failure, prior year hospitalization, ED visit, and prior year pacing procedure were significant predictors of mortality. Age ≥ 65, male sex, and prior year hospitalization were significant predictors of a composite measure of device-related complications. CCI and prior hospitalization were significant predictors of a composite measure of any adverse outcome. CONCLUSIONS Results suggest most patients in an older population do not experience adverse outcomes in the year following ICD implantation. The risk of mortality may be greater in men, patients over the age of 65, and patients with greater general morbidity, heart failure, or a history of a pacing procedure.
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Witt CM, Waks JW, Mehta RA, Friedman PA, Kramer DB, Buxton AE, Mulpuru SK, Noseworthy PA, Hodge DO, Lushinsky EC, Mulholland MB, Cha YM, Gersh BJ, Madhavan M. Risk of Appropriate Therapy and Death Before Therapy After Implantable Cardioverter-Defibrillator Generator Replacement. Circ Arrhythm Electrophysiol 2018; 11:e006155. [DOI: 10.1161/circep.117.006155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Chance M. Witt
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
| | - Jonathan W. Waks
- Mayo Clinic, Rochester, MN. Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (J.W.W., D.B.K., A.E.B.)
| | | | - Paul A. Friedman
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
| | - Daniel B. Kramer
- Mayo Clinic, Rochester, MN. Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (J.W.W., D.B.K., A.E.B.)
| | - Alfred E. Buxton
- Mayo Clinic, Rochester, MN. Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (J.W.W., D.B.K., A.E.B.)
| | - Siva K. Mulpuru
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
| | - Peter A. Noseworthy
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
| | | | - Emilie C. Lushinsky
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
| | - Megan B. Mulholland
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
| | - Bernard J. Gersh
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
| | - Malini Madhavan
- Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)
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Iorio A, Senni M, Barbati G, Greene SJ, Poli S, Zambon E, Di Nora C, Cioffi G, Tarantini L, Gavazzi A, Sinagra G, Di Lenarda A. Prevalence and prognostic impact of non-cardiac co-morbidities in heart failure outpatients with preserved and reduced ejection fraction: a community-based study. Eur J Heart Fail 2018; 20:1257-1266. [PMID: 29917301 DOI: 10.1002/ejhf.1202] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/26/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
AIM To assess adverse outcomes attributable to non-cardiac co-morbidities and to compare their effects by left ventricular ejection fraction (LVEF) group [LVEF <50% (heart failure with reduced ejection fraction, HFrEF), LVEF ≥50% (heart failure with preserved ejection fraction, HFpEF)] in a contemporary, unselected chronic heart failure population. METHODS AND RESULTS This community-based cohort enrolled patients from October 2009 to December 2013. Adjusted hazard ratio (HR) and the population attributable fraction (PAF) were used to compare the contribution of 15 non-cardiac co-morbidities to adverse outcome. Overall, 2314 patients (mean age 77 ±10 years, 57% men) were recruited [n = 941 (41%) HFrEF, n = 1373 (59%) HFpEF]. Non-cardiac co-morbidity rates were similarly high, except for obesity and hypertension which were more prevalent in HFpEF. At a median follow-up of 31 (interquartile range 16-41) months, 472 (20%) patients died. Adjusted mortality rates were not significantly different between the HFrEF and HFpEF groups. After adjustment, an increasing number of non-cardiac co-morbidities was associated with a higher risk for all-cause mortality [HR 1.25; 95% confidence interval (CI) 1.10-1.26; P < 0.001], all-cause hospitalization (HR 1.17; 95% CI 1.12-1.23; P < 0.001), heart failure hospitalization (HR 1.28; 95% CI 1.19-1.38; P < 0.001), non-cardiovascular hospitalization (HR 1.16; 95% CI 1.11-1.22; P < 0.001). The co-morbidities contributing to high PAF were: anaemia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and peripheral artery disease. These findings were similar for HFrEF and HFpEF. Interaction analysis yielded similar results. CONCLUSIONS In a contemporary community population with chronic heart failure, non-cardiac co-morbidities confer a similar contribution to outcomes in HFrEF and HFpEF. These observations suggest that quality improvement initiatives aimed at optimizing co-morbidities may be similarly effective in HFrEF and HFpEF.
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Affiliation(s)
- Annamaria Iorio
- Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.,Cardiovascular Department, University of Trieste, Italy
| | - Michele Senni
- Cardiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Stefano Poli
- Cardiovascular Department, University of Trieste, Italy
| | - Elena Zambon
- Cardiovascular Department, University of Trieste, Italy
| | | | | | - Luigi Tarantini
- Heart Failure Clinic, Division of Cardiology, San Martino Hospital, Belluno, Italy
| | - Antonello Gavazzi
- FROM - Clinical Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Metra M. June 2018 at a glance: peripartum cardiomyopathy and pathophysiology, prognosis, and device therapy of heart failure. Eur J Heart Fail 2018; 20:949-950. [DOI: 10.1002/ejhf.1004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties Radiological Sciences, and Public Health, University of Brescia Italy
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36
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Sharma A, Al-Khatib SM, Ezekowitz JA, Cooper LB, Fordyce CB, Michael Felker G, Bardy GH, Poole JE, Thomas Bigger J, Buxton AE, Moss AJ, Friedman DJ, Lee KL, Steinman R, Dorian P, Cappato R, Kadish AH, Kudenchuk PJ, Mark DB, Peterson ED, Inoue LYT, Sanders GD. Implantable cardioverter-defibrillators in heart failure patients with reduced ejection fraction and diabetes. Eur J Heart Fail 2018; 20:1031-1038. [PMID: 29761861 DOI: 10.1002/ejhf.1192] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/03/2018] [Accepted: 03/08/2018] [Indexed: 12/28/2022] Open
Abstract
AIM There is limited information on the outcomes after primary prevention implantable cardioverter-defibrillator (ICD) implantation in patients with heart failure (HF) and diabetes. This analysis evaluates the effectiveness of a strategy of ICD plus medical therapy vs. medical therapy alone among patients with HF and diabetes. METHODS AND RESULTS A patient-level combined-analysis was conducted from a combined dataset that included four primary prevention ICD trials of patients with HF or severely reduced ejection fractions: Multicenter Automatic Defibrillator Implantation Trial I (MADIT I), MADIT II, Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE), and Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). In total, 3359 patients were included in the analysis. The primary outcome of interest was all-cause death. Compared with patients without diabetes (n = 2363), patients with diabetes (n = 996) were older and had a higher burden of cardiovascular risk factors. During a median follow-up of 2.6 years, 437 patients without diabetes died (178 with ICD vs. 259 without) and 280 patients with diabetes died (128 with ICD vs. 152 without). ICDs were associated with a reduced risk of all-cause mortality among patients without diabetes [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.67] but not among patients with diabetes (HR 0.88, 95% CI 0.7-1.12; interaction P = 0.015). CONCLUSION Among patients with HF and diabetes, primary prevention ICD in combination with medical therapy vs. medical therapy alone was not significantly associated with a reduced risk of all-cause death. Further studies are needed to evaluate the effectiveness of ICDs among patients with diabetes.
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Affiliation(s)
- Abhinav Sharma
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren B Cooper
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - G Michael Felker
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Gust H Bardy
- Seattle Institute for Cardiac Research, Seattle, WA, USA
| | | | - J Thomas Bigger
- Department of Medicine, Columbia University, New York, NY, USA
| | - Alfred E Buxton
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Arthur J Moss
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, MN, USA
| | | | - Kerry L Lee
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Richard Steinman
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
| | - Paul Dorian
- Departments of Medicine and Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Riccardo Cappato
- IRCCS Policlinico San Donato, Milan, Italy.,Humanitas Clinical And Research Center, via Manzoni 56 20089 Rozzano (Mi).,Humanitas University Department of Biomedical Sciences Via Rita Levi Montalcini 4 Pieve Emanuele (Mi)
| | - Alan H Kadish
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Lurdes Y T Inoue
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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37
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Ameri P, Canepa M, Anker MS, Belenkov Y, Bergler-Klein J, Cohen-Solal A, Farmakis D, López-Fernández T, Lainscak M, Pudil R, Ruschitska F, Seferovic P, Filippatos G, Coats A, Suter T, Von Haehling S, Ciardiello F, de Boer RA, Lyon AR, Tocchetti CG. Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge. Eur J Heart Fail 2018; 20:879-887. [PMID: 29464808 DOI: 10.1002/ejhf.1165] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/24/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022] Open
Abstract
Cancer and heart failure (HF) are common medical conditions with a steadily rising prevalence in industrialized countries, particularly in the elderly, and they both potentially carry a poor prognosis. A new diagnosis of malignancy in subjects with pre-existing HF is not infrequent, and challenges HF specialists as well as oncologists with complex questions relating to both HF and cancer management. An increased incidence of cancer in patients with established HF has also been suggested. This review paper summarizes the epidemiology and the prognostic implications of cancer occurrence in HF, the impact of pre-existing HF on cancer treatment decisions and the impact of cancer on HF therapeutic options, while providing some practical suggestions regarding patient care and highlighting gaps in knowledge.
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Affiliation(s)
- Pietro Ameri
- Department of Internal Medicine, University of Genova; and Cardiology Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genova; and Cardiology Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
| | - Markus S Anker
- Department of Cardiology (CBF), Charité University Medicine, Berlin, Germany; AND Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia; Department of Internal Medicine & Cardiology; and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Berlin, Germany
| | | | | | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, Paris, France; U942 INSERM, BIOCANVAS (Biomarqueurs Cardiovasculaires), Paris, France;, Department of Cardiology, University of Paris VII Denis Diderot, Paris, France
| | - Dimitrios Farmakis
- Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens University Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Teresa López-Fernández
- Cardio-Oncology Unit, Cardiac Imaging Unit, Department of Cardiology, La Paz University Hospital, IdiPAz, Madrid, Spain
| | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education, General Hospital Celje, Celje, Slovenia, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Radek Pudil
- 1st Department of Medicine - Cardioangiology, Medical Faculty and University Hospital Hradec Kralove, Czech Republic
| | - Frank Ruschitska
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Gerasimos Filippatos
- Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens University Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew Coats
- Monash University, Australia and University of Warwick, UK
| | - Thomas Suter
- Department of Cardiology, Cardio-Oncology, Bern University Hospital, Bern, Switzerland
| | - Stephan Von Haehling
- Klinik für Kardiologie und Pneumologie, Herzzentrum Göttingen, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Germany;, Deutsches Zentrum für Herz- und Kreislaufforschung, Standort Göttingen, Göttingen, Germany
| | - Fortunato Ciardiello
- Department of Clinical and Experimental Medicine "Flaviano Magrassi", Luigi Vanvitelli University of Campania, Naples, Italy
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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38
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Lund LH. Complex relationships between co-morbidity, outcomes, and treatment effect in heart failure. Eur J Heart Fail 2018; 20:511-513. [PMID: 29316135 DOI: 10.1002/ejhf.1107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/15/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Heart and Vascular Theme, Stockholm, Sweden
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Gasparini M, Kloppe A, Lunati M, Anselme F, Landolina M, Martinez-Ferrer JB, Proclemer A, Morani G, Biffi M, Ricci R, Rordorf R, Mangoni L, Manotta L, Grammatico A, Leyva F, Boriani G. Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy: positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations. Eur J Heart Fail 2017; 20:1472-1481. [PMID: 29251799 DOI: 10.1002/ejhf.1117] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS We sought to determine whether atrioventricular junction ablation (AVJA) in patients with cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD) and with permanent atrial fibrillation (AF) has a positive impact on ICD shocks and hospitalizations compared with rate-slowing drugs. METHODS AND RESULTS This is a pooled analysis of data from 179 international centres participating in two randomized trials and one prospective observational research. The co-primary endpoints were all-cause ICD shocks and all-cause hospitalizations. Out of 3358 CRT-ICD patients (2720 male, 66.6 years), 2694 (80%) were in sinus rhythm (SR) and 664 (20%) had permanent AF-262 (8%) treated with AVJA (AF + AVJA) and 402 (12%) treated with rate-slowing drugs (AF + Drugs). Median follow-up was 18 months. The mean (95% confidence intervals) annual rate of all-cause ICD shocks per 100 patient years was 8.0 (5.3-11.9) in AF + AVJA, 43.6 (37.7-50.4) in AF + Drugs, and 34.4 (32.5-36.5) in SR patients, resulting in incidence rate ratio (IRR) reductions of 0.18 (0.10-0.32) for AF + AVJA vs. AF + Drugs (P < 0.001) and 0.48 (0.35-0.66) for AF + AVJA vs. SR (P < 0.001). These reductions were driven by significant reductions in both appropriate ICD shocks [IRR 0.23 (0.13-0.40), P < 0.001, vs. AF + Drugs] and inappropriate ICD shocks [IRR 0.09 (0.04-0.21), P < 0.001, vs. AF + Drugs]. Annual rate of all-cause hospitalizations was significantly lower in AF + AVJA vs. AF + Drugs [IRR 0.57 (0.41-0.79), P < 0.001] and SR [IRR 0.85 (073-0.98), P = 0.027]. CONCLUSION In AF patients treated with CRT, AVJA results in a lower incidence and burden of all-cause, appropriate and inappropriate ICD shocks, as well as to fewer all-cause and heart failure hospitalizations. CLINICAL TRIAL REGISTRATION NCT00147290, NCT00617175, NCT01007474.
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Affiliation(s)
- Maurizio Gasparini
- Electrophysiology and Pacing Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Axel Kloppe
- Department of Cardiology, Ruhr-Universität-Bochum, Bochum, Germany
| | | | - Frédéric Anselme
- Cardiology Department, University Hospital C. Nicolle, Rouen, France
| | | | | | | | - Giovanni Morani
- Cardiology Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna and Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy
| | - Renato Ricci
- Department of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Roberto Rordorf
- Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | | | - Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
| | - Giuseppe Boriani
- Cardiology Department, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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40
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Boriani G, Malavasi VL. Extending survival by reducing sudden death with implantable cardioverter-defibrillators: a challenging clinical issue in non-ischaemic and ischaemic cardiomyopathies. Eur J Heart Fail 2017; 20:420-426. [PMID: 29164794 DOI: 10.1002/ejhf.1080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/26/2017] [Accepted: 10/15/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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41
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Boriani G, Malavasi VL. Patient outcome after implant of a cardioverter defibrillator in the ‘real world’: the key role of co-morbidities. Eur J Heart Fail 2017; 19:387-390. [DOI: 10.1002/ejhf.743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/08/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division. Department of Diagnostics, Clinical and Public Health Medicine; University of Modena and Reggio Emilia; Policlinico di Modena Modena Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division. Department of Diagnostics, Clinical and Public Health Medicine; University of Modena and Reggio Emilia; Policlinico di Modena Modena Italy
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