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Use of Primary Prevention Implantable Cardioverter-Defibrillator in a Population-Based Cohort Is Associated With a Significant Survival Benefit
Study Questions:
Does the implantable cardioverter-defibrillator (ICD) improve survival in community-based cohorts of patients who qualify for an ICD for primary prevention of sudden cardiac death (SCD)?
Methods:
The selection criteria in this retrospective study were an ejection fraction (EF) ≤35% plus heart failure or an EF ≤30% plus coronary artery disease (CAD). A group of 717 patients who were eligible for an ICD was identified from a heart failure/CAD registry. An ICD was implanted in 116 of these patients (16%), and the remaining 601 patients (mean age 69 years, mean EF 26%) made up the no-ICD cohort. A second cohort of 290 patients (mean age 65 years, mean EF 24%) who were eligible for and did receive an ICD was identified from an ICD registry. The primary outcome was all-cause mortality during a mean follow-up of 2.7 years.
Results:
The 5-year survival rate was significantly higher in the ICD cohort (78.6%) than in the no-ICD cohort (61.2%). In 252 patients from each group who were matched based on propensity analysis, mortality was significantly lower by 41% in the ICD cohort. During follow-up, 26% of patients in the ICD cohort received an appropriate ICD therapy.
Conclusions:
ICDs improve survival in community-based cohorts of patients who qualify for an ICD for primary prevention of SCD. A large proportion of patients who qualify for an ICD do not receive a device.
Perspective:
This study confirms the notable degree of underutilization of ICDs for primary prevention of SCD. The major contribution of the study is the demonstration that the results of randomized clinical ICD trials apply to ‘real-world’ patients.
Keywords: Coronary Artery Disease, Heart Failure, Defibrillators, Implantable, Primary Prevention
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