Letter by Boriani et al regarding article, "Death without prior appropriate implantable cardioverter-defibrillator therapy: a competing risk study".
نویسندگان
چکیده
BACKGROUND Implantable cardioverter-defibrillators (ICDs) improve survival in selected patients with left ventricular systolic dysfunction in randomized trials. Competing death without prior appropriate ICD therapy might preclude benefit from ICD implantation in a less selected routine-care population. METHODS AND RESULTS We selected all patients with ischemic or dilated cardiomyopathy with an ICD implanted for primary or secondary prevention from a single-center prospective registry between 1994 and 2006. The end point was time to first appropriate ICD therapy/confirmed ventricular fibrillation or death without prior appropriate ICD therapy. We analyzed cumulative incidence functions and used competing risk regression to study predictors of appropriate ICD therapy or prior death. In 442 patients, 73 deaths occurred during a median follow-up of 3.6 years (maximum, 12.7 years). The cumulative incidence of first appropriate ICD therapy until year 7 was 52%, whereas 11% died without prior ICD therapy. The cumulative incidence of appropriate ICD therapy for ventricular fibrillation was 13%, whereas 23% died without prior therapy for ventricular fibrillation. Appropriate ICD therapy was twice as likely in secondary prevention compared with primary prevention, whereas death rates before ICD therapy were similar in both groups. Diuretic use for heart failure compared with nonuse predicted a 4-fold-increased risk of death prior to ICD therapy, although the incidence of appropriate ICD therapy was similar in both groups. CONCLUSIONS In a contemporary ICD population, the risk of death without prior appropriate ICD therapy is substantial, especially in patients with advanced heart failure.
منابع مشابه
Death Without Prior Appropriate Implantable Cardioverter-Defibrillator Therapy A Competing Risk Study
Background—Implantable cardioverter-defibrillators (ICDs) improve survival in selected patients with left ventricular systolic dysfunction in randomized trials. Competing death without prior appropriate ICD therapy might preclude benefit from ICD implantation in a less selected routine-care population. Methods and Results—We selected all patients with ischemic or dilated cardiomyopathy with an ...
متن کاملDeath Without Prior Appropriate Implantable Cardioverter-Defibrillator Therapy
Background—Implantable cardioverter-defibrillators (ICDs) improve survival in selected patients with left ventricular systolic dysfunction in randomized trials. Competing death without prior appropriate ICD therapy might preclude benefit from ICD implantation in a less selected routine-care population. Methods and Results—We selected all patients with ischemic or dilated cardiomyopathy with an ...
متن کاملLetter by Lin et al regarding article, "Heart rate predicts outcomes in an implantable cardioverter-defibrillator population".
متن کامل
THE EFFECT OF NURSE-PEER-LED SUPPORT INTERVENTION ON QUALITY OF LIFE IN PATIENTS WITH AN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR: A RANDOMIZED CLINICAL TRIAL
Background & Aims: Nowadays, the quality of life and how coping and treatment of patients with an implantable cardiac defibrillator has led to concern and attempts to reduce or eliminate the problems of these patients in the people who provide health care services. This study aimed to determine the effect of nurse-peer-led support intervention on quality of life in patients with an implantable ...
متن کاملImplantable cardioverter-defibrillator in a patient with dextrocardia situs inversus
Background: Dextrocardia is a congenital anomaly, which may have coexistent coronary artery disease (CAD), arrhythmias and conventional indications for device therapy. However, the implantation of transvenous leads can be technically challenging and the approach needs to be tailored to the patient's individual anatomy. Case presentation: A 54-year-old male with dextrocardia situs inversus and i...
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عنوان ژورنال:
- Circulation
دوره 118 14 شماره
صفحات -
تاریخ انتشار 2008