Efficacy of an implantable cardioverter-defibrillator in patients with diabetes and heart failure and reduced ejection fraction
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- Rørth2019_Article_EfficacyOfAnImplantableCardiov
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BACKGROUND: The effect of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure with reduced ejection fraction (HFrEF) and diabetes is not fully elucidated.
METHODS: We examined the effect of ICD therapy on sudden cardiac death, cardiovascular death and all-cause mortality, according to diabetes status at baseline in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). The outcomes were analyzed by use of cumulative incidence curves and Cox regressions models.
RESULTS: Of the 1676 patients randomized to an ICD or placebo, 540 (32%) had diabetes at baseline. Patients with diabetes were slightly older (61 vs 58 years) and were more often in NYHA class III (37% vs 28%). ICD therapy did not reduce the risk of sudden cardiac death in HFrEF patients with diabetes (HR = 0.85; 95% CI 0.52-1.40); even though these patients had a higher risk of sudden cardiac death compared to patients without diabetes (HR = 1.73 95% CI 1.22-2.47). By contrast, ICD therapy did reduce sudden cardiac death in HFrEF patients without diabetes (HR = 0.26; 95% CI 0.15-0.46); Pinteraction=0.002. The findings for cardiovascular and all-cause death were similar.
CONCLUSION: ICD therapy did not reduce the risk of sudden cardiac death (or, as a consequence, all-cause death) in HFrEF patients with diabetes. Conversely, an ICD reduced the risk of sudden death in patients without diabetes, irrespective of etiology.
Original language | English |
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Journal | Clinical Research in Cardiology |
Volume | 108 |
Issue number | 8 |
Pages (from-to) | 868-877 |
Number of pages | 10 |
ISSN | 1861-0684 |
DOIs | |
Publication status | Published - Aug 2019 |
- Aged, Amiodarone/administration & dosage, Cause of Death/trends, Death, Sudden, Cardiac/prevention & control, Defibrillators, Implantable, Diabetes Mellitus/epidemiology, Dose-Response Relationship, Drug, Female, Heart Failure/epidemiology, Humans, Incidence, Male, Middle Aged, Risk Factors, Stroke Volume/physiology, Survival Rate/trends, Treatment Outcome, United Kingdom/epidemiology, Vasodilator Agents/administration & dosage
Research areas
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