Implantable cardioverter‐defibrillators in heart failure patients with reduced ejection fraction and diabetes

• Published in: European journal of heart failure Vol. 20; no. 6; pp. 1031 - 1038
• Main Authors: Sharma, Abhinav, Al‐Khatib, Sana M., Ezekowitz, Justin A., Cooper, Lauren B., Fordyce, Christopher B., Michael Felker, G., Bardy, Gust H., Poole, Jeanne E., Thomas Bigger, J., Buxton, Alfred E., Moss, Arthur J., Friedman, Daniel J., Lee, Kerry L., Steinman, Richard, Dorian, Paul, Cappato, Riccardo, Kadish, Alan H., Kudenchuk, Peter J., Mark, Daniel B., Peterson, Eric D., Inoue, Lurdes Y.T., Sanders, Gillian D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK John Wiley & Sons, Ltd 01-06-2018
• Subjects: Comorbidity - trends; Comparative effectiveness; Competing risk; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Diabetes; Diabetes Mellitus - epidemiology; Female; Heart failure; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Implantable cardioverter‐defibrillator; Incidence; Male; Middle Aged; Primary Prevention - methods; Stroke Volume - physiology; Survival Rate - trends; United States - epidemiology; United States; Heart failure; Comparative effectiveness; Diabetes; Implantable cardioverter-defibrillator; Competing risk
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.1192

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.