Is the clinical benefit of implantable cardioverter-defibrillators in heart failure patients declining?

Spartalis, Μichael; Iliopoulos, Dimitrios; Spartalis, Eleftherios; Athanasiou, Antonios; Paschou, Stavroula Α.; Voudris, Vassilis; Siasos, Gerasimos

doi:10.1016/j.jjcc.2020.02.002

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…Considering that 82% of total patients did not have sustained ventricular arrhythmias over the 4.8-year period, our study, although small, raises ethical questions about the pros and cons of having a device implanted, and validity of current ICD selection criteria. Notwithstanding, the life-saving potential of having a device, the clinical criteria for deciding who needs a primary prevention ICD is imprecise (8,14,40). Notwithstanding these important issues, three patients would have likely died without their ICD ( Table 5).…”

Section: Risk/benefit and Cost Considerations Of Icd Implantationmentioning

confidence: 99%

“…Notwithstanding the small clinical risks of device insertion (12), the most common problems of the ICD include lead failure, premature battery life, failure of algorithms to discriminate ventricular from supraventricular arrhythmias, device activation when shocks are not required, and patient anxiety issues (e.g., anticipatory "phantom shocks") (8,13). Despite the potential of ICDs to save lives, there is increasing controversy about who should receive a device, and their clinical efficacy (8,14). Differences in patient outcomes appear to reflect the complexity of multiple phenotypes of heart failure with different comorbidities, the selection criteria based on ejection fraction classification, and lack of consensus guidelines for patient selection (4,8,13,15).…”

Section: Introductionmentioning

confidence: 99%

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Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective

Engstrom

Dobson

et al. 2020

Front. Cardiovasc. Med.

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Background: Despite major advances in treating patients with severe heart failure, deciding who should receive an implantable cardiac defibrillator (ICD) remains challenging. Objective: To study the risk factors and mortality in patients after receiving an ICD (January 2008-December 2015) in a regional hospital in Australia. Methods: Eighty-two primary prevention patients received an ICD for ischemic cardiomyopathy (ICM, n = 41) and non-ischemic cardiomyopathy (NICM, n = 40) with 4.8-yrs follow-up. One patient had mixed ICM/NICM indications. Ventricular arrhythmias were assessed using intracardiac electrograms. Statistical analysis compared the total population and ICM and NICM groups using Kaplan-Meier for survival, Cox regression for mortality predictors, and binary logistic regression for predictors of ventricular arrhythmias (p < 0.05). Results: Major risk factors were hypercholesterolemia (70.7%), hypertension (47.6%), and obesity (41.5%). Severe obstructive sleep apnea (OSA) was found exclusively in NICM patients (23.7%, p = 0.001). Mortality was 30.5% after 4.8-yrs. The majority of patients (n=67) had no sustained ventricular arrhythmias yet 28% received therapy (n = 23), 18.51% were appropriate (n = 15), and 13.9% inappropriate (n = 11). Patients receiving ≥2 incidences of inappropriate shocks were 18-times more likely to die (p = 0.013). Three sudden cardiac deaths (SCD) (3.7%) were prevented by the ICD. Conclusion: Patients implanted with an ICD in Townsville had 30.5% all-cause mortality after 4.8-yrs. Only 28% of patients received ICD therapy and 13.9% were inappropriate. OSA may have contributed to the fourfold increase in inappropriate therapy in NICM patients. Our study raises important efficacy, ethical and healthcare cost questions about who should receive an ICD, and possible regional and urban center disparities.

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Section: Risk/benefit and Cost Considerations Of Icd Implantationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective

Engstrom

Dobson

et al. 2020

Front. Cardiovasc. Med.

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“…Recently, the study of subcutaneous ICD implantation in dilated cardiomyopathy (DCM) patients with ICD indications reported efficacy against ventricular arrhythmias. Subcutaneous ICD, which has a lower risk of infection than intravenous ICD, is a useful option for younger DCM patients without CRT indication [24,25].…”

Section: Discussionmentioning

confidence: 99%

Implantable Cardioverter Defibrillator Therapy in Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction: An Observation from the KCHF Registry

Hata

Kato

Morimoto

et al. 2021

Journal of Cardiology

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“…In a post hoc study of SCDHeFT, it was discovered that ICD shocks, whether appropriate or not, were correlated with a lower rate of survival in ICD patients [58][59][60]. Much research has shown that shocks can be minimized by proper programming, which allows for longer detections and durations before shock initiation [60].…”

Section: Novel Concepts In Defibrillator Therapy In Hfmentioning

confidence: 99%

Contemporary ICD Use in Patients with Heart Failure

et al. 2021

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Despite constant breakthroughs in heart failure (HF) therapy, the population of HF patients resume to grow and is linked to increased mortality and morbidity. Ventricular arrhythmias (VA) are one of the leading causes of mortality in HF subjects. Implantable cardioverter-defibrillators (ICDs) are currently the gold standard in treatment, preventing arrhythmic sudden cardiac death (SCD) episodes. However, the death rates related to HF remain elevated, as not all HF subjects benefit equally. Cardiac resynchronization therapy (CRT) has emerged as a novel approach for HF patients. These devices have been thoroughly investigated in major randomized controlled studies but continue to be underutilized in various countries. This review discusses the use of ICD in HF populations on top of treatments.

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Is the clinical benefit of implantable cardioverter-defibrillators in heart failure patients declining?

Cited by 3 publications

References 5 publications

Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective

Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective

Implantable Cardioverter Defibrillator Therapy in Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction: An Observation from the KCHF Registry

Contemporary ICD Use in Patients with Heart Failure

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