Outcomes of implantable cardioverter-defibrillator use in patients with comorbidities: Results from a combined analysis of 4 randomized clinical trials

Benjamin A. Steinberg, Sana M. Al-Khatib, Rex Edwards, JooYoon Han, Gust H. Bardy, J. Thomas Bigger, Alfred E. Buxton, Arthur J. Moss, Kerry L. Lee, Richard Steinman, Paul Dorian, Alfred Hallstrom, Riccardo Cappato, Alan H. Kadish, Peter J. Kudenchuk, Daniel B. Mark, Lurdes Y T Inoue, Gillian D. Sanders

Research output: Contribution to journalArticle

Abstract

Objectives: The aim of this study was to determine if the benefit of implantable cardioverter-defibrillators (ICDs) ismodulated by medical comorbidity. Background: Primary prevention ICDs improve survival in patients at risk for sudden cardiac death. Their benefit inpatients with significant comorbid illness has not been demonstrated. Methods: Original, patient-level datasets from MADIT I (Multicenter Automatic Defibrillator Implantation Trial I), MADIT II, DEFINITE (Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation), and SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) were combined. Patients in the combined population (N= 3,348) were assessed with respect to the following comorbidities: smoking, pulmonary disease, diabetes, peripheral vascular disease, atrial fibrillation, ischemic heart disease, and chronic kidney disease. The primary outcome was overall mortality, using the hazard ratio (HR) of time to death for patients receiving an ICD versus no ICD by extent of medical comorbidity, and adjusted for age, sex, race, left ventricular ejection fraction, use of antiarrhythmic drugs, beta-blockers, and angiotensin-converting enzyme inhibitors. Results: Overall, 25% of patients (n= 830) had

Original languageEnglish
Pages (from-to)623-629
Number of pages7
JournalJACC: Heart Failure
Volume2
Issue number6
DOIs
Publication statusPublished - 2014

Keywords

  • Comorbid illness
  • Implantable cardioverter-defibrillator
  • Outcomes
  • Randomized trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Steinberg, B. A., Al-Khatib, S. M., Edwards, R., Han, J., Bardy, G. H., Bigger, J. T., Buxton, A. E., Moss, A. J., Lee, K. L., Steinman, R., Dorian, P., Hallstrom, A., Cappato, R., Kadish, A. H., Kudenchuk, P. J., Mark, D. B., Inoue, L. Y. T., & Sanders, G. D. (2014). Outcomes of implantable cardioverter-defibrillator use in patients with comorbidities: Results from a combined analysis of 4 randomized clinical trials. JACC: Heart Failure, 2(6), 623-629. https://doi.org/10.1016/j.jchf.2014.06.007