Survival and arrhythmic risk among ischemic and non-ischemic heart failure patients with prophylactic implantable cardioverter defibrillator only therapy: A propensity score-matched analysis

• Published in: International journal of cardiology Vol. 274; pp. 163 - 169
• Main Authors: Briongos-Figuero, Sem, Estévez, Alvaro, Luisa Pérez, M., Martínez-Ferrer, José B., García, Enrique, Viñolas, Xavier, Arenal, Ángel, Alzueta, Javier, Basterra, Nuria, Rodríguez, Aníbal, Lozano, Ignacio, Muñoz-Aguilera, Roberto
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-01-2019
• Subjects: Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - prevention & control; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Electrocardiography; Female; Follow-Up Studies; Heart Failure - complications; Heart Failure - mortality; Heart Failure - therapy; Humans; Implantable cardioverter defibrillator; Incidence; Male; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - mortality; Non-ischemic cardiomyopathy; Primary Prevention; Prognosis; Propensity Score; Retrospective Studies; Risk Assessment - methods; Risk Factors; Secondary Prevention; Spain - epidemiology; Survival Rate - trends; Survival, arrhythmic risk; Spain; Survival, arrhythmic risk; Implantable cardioverter defibrillator; Non-ischemic cardiomyopathy
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.09.003

Concerns about the efficacy of prophylactic ICD in non-ischemic cardiomyopathy (NICM) heart failure (HF) patients are still present. We aimed to assess whether survival and arrhythmic risk were different among ischemic cardiomyopathy (ICM) and NICM ICD-only patients, along with specific predictors for mortality.
HF patients undergoing ICD-only implant were extracted from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.
782 patients (556 ICM; 226 NICM) were recruited: mean ejection fraction of 26.6%; 83.4% in NYHA class II-III; mean QRS duration of 108.9 ms (only 14.9% with QRS > 130 ms). After 4.35 years of mean follow-up, all-cause mortality rate was 4.2%/year. In propensity-score (PS) analysis no survival differences between ICM and NICM subgroups appeared (mortality rates: 19.4% vs. 20%, p = 0.375). Age (hazard ratio [HR] = 1.02, p = 0.009), diabetes (HR = 2.61, p ≤ 0.001), chronic obstructive pulmonary disease (HR = 2.13, p = 0.002), and previous HF (HR = 2.28, p = 0.027) correlated with increased mortality for the entire population, however atrial fibrillation (AF) (HR = 2.68, p = 0.002) and chronic kidney disease (HR = 3.74, p ≤ 0.001) emerged as specific predictors in NICM patients. At follow-up, 134 patients (17.1%) were delivered a first appropriate ICD therapy (5.1%/year) without significant differences between ICM and NICM patients in the PS analysis (17.6% vs. 15.8%, p = 0.968). ICD shocks were associated with a higher mortality (HR = 2.88, p < 0.001) but longer detection windows (HR = 0.57, p = 0.042) correlated with fewer appropriate therapies.
Mortality and arrhythmia free survival is similar among ICM and NICM HF patients undergoing ICD-only implant for primary prevention strategy.
•This is the first real-world registry analysing hard endpoints in prophylactic ICD-only HF patients with narrow QRS complex.•A propensity-score analysis has never been performed in this clinical setting.•All-cause death and arrhythmic risks were similar among ischemic and non-ischemic patients after four years of mean follow-up.•The benefit in non-ischemic HF patients might be the same, so ICD therapy should not be restricted to ischemic patients.•The decision to implant and ICD must be individualized in patients with more comorbidity.