Randomized Study of Implantable Defibrillator as First-Choice Therapy Versus Conventional Strategy in Postinfarct Sudden Death Survivors

Wever, Eric F.D.; Hauer, Richard N.W.; Capelle, F. J. L. Van; Tijssen, Jan G.P.; Crijns, Harry J.G.M.; Algra, Ale; Wiesfeld, Ans C.P.; Bakker, Patricia F.A.; Medina, Etienne O. Robles de

doi:10.1161/01.cir.91.8.2195

Cited by 208 publications

(62 citation statements)

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“…et al, 1 Schläpfer et al, 8 and the Multicenter Unsustained Tachycardia Trial (MUSTT), 4 the curves appear to diverge earlier. In fact, there are no peculiarities of the former trials to explain the unique delayed survival benefit effect.…”

Section: Salukhe Et Al Defibrillator Benefit Rises More Than Linearlymentioning

confidence: 98%

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Life-Years Gained From Defibrillator Implantation

et al. 2004

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Background— Although treatment benefit in randomized controlled trials of defibrillators is often summarized by the numbers of lives saved (absolute risk difference), this may not be a good representation of what matters most to patients, namely, the amount of life they should expect to gain from implantation. The estimate of gain in life-years may depend on duration of follow-up. In this study, we examine this dependency. Methods and Results— We estimated, from published data of 8 landmark defibrillator trials, the cumulative benefit in life-years gained at time points from 3 months to 3 years. Because the trial populations, clinical status, and prognosis varied widely between studies, we expressed for each study the benefit at each time point as the proportion of benefit at 3 years. The average dependency of the benefit on duration of follow-up was then calculated. We found that the number of life-years gained from 1 device implantation increases with length of follow-up considered. Importantly, this increase is markedly nonlinear. Within the 3-year span addressable, the benefit rises with the square of time (gain ∞ t 1.94 , R 2 =0.998, P <0.001). Conclusions— Measurable benefit from a defibrillator to patients’ life spans (life-years gained) is dramatically dependent on the time window over which the benefit is assessed. Because the effort of implantation is front loaded, yet benefit grows with time, the choice of an early time point artificially reduces apparent benefit and artificially increases the apparent number needed to treat to prevent an event. These are useful considerations for the formulation of treatment policy (and even for planning of the follow-up phase of clinical trials).

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Section: Salukhe Et Al Defibrillator Benefit Rises More Than Linearlymentioning

confidence: 98%

“…[1][2][3][4][5][6][7][8] Their characteristics are shown in Table 1. Seven were randomized, and in the eighth, 8 patients were allocated by sensitivity to amiodarone.…”

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

Life-Years Gained From Defibrillator Implantation

et al. 2004

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“…(7)(8)(9)(10)(11)(12) Studies evaluating the secondary prevention of SCD have consistently shown better survival with ICD therapy compared to anti-arrhythmic medications. (12) The Sudden Cardiac Death in Heart Failure Trial (SCDHeFT) and Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) provided evidence supporting ICD use for the primary prevention of SCD in patients with LV dysfunction.…”

Section: Implantable Cardioverter Defibrillatormentioning

confidence: 99%

Overview of implantable cardioverter defibrillator and cardiac resynchronisation therapy in heart failure management

Chia¹,

Foo²

2016

smedj

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Clinical trials have established the benefits of implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) in the treatment of heart failure patients. As adjuncts to guideline-directed medical therapy, ICDs confer mortality benefits from sudden cardiac arrest, while CRT reduces mortality, hospitalisation rates and improves functional capacity. This review discusses the use of ICDs and CRT devices in heart failure management, outlining the evidence supporting their use, indications and contraindications.

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“…The first trial to investigate the use of ICD as first choice treatment in survivors of cardiac arrest compared with antiarrhythmic drugs was the Dutch study [40]. In a relatively small population of 60 patients, a strategy of ICD implantation as first-line treatment was shown to be preferable to medical therapy, conferring a significant reduction of a combined endpoint of main outcome events, included death, recurrent cardiac arrest, and cardiac transplantation.…”

Section: Secondary Scd Preventionmentioning

confidence: 99%