Abstract
Background: No precise tools exist to predict appropriate shocks in patients with a primary prevention ICD. We sought to identify characteristics predictive of appropriate shocks in patients with a primary prevention implantable cardioverter defibrillator (ICD). Methods: Using patient-level data from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), we identified patients with any appropriate shock. Clinical and demographic variables were included in a logistic regression model to predict appropriate shocks. Results: There were 1,463 patients randomized to an ICD, and 285 (19%) had ≥1 appropriate shock over a median follow-up of 2.59 years. Compared with patients without appropriate ICD shocks, patients who received any appropriate shock tended to have more severe heart failure. In a multiple logistic regression model, predictors of appropriate shocks included NYHA class (NYHA II vs. I: OR 1.65, 95% CI 1.07–2.55; NYHA III vs. I: OR 1.74, 95% CI 1.10–2.76), lower LVEF (per 1% change) (OR 1.04, 95% CI 1.02–1.06), absence of beta-blocker therapy (OR 1.61, 95% CI 1.23–2.12), and single chamber ICD (OR 1.67, 95% CI 1.13–2.45). Conclusion: In this meta-analysis of patient level data from MADIT-II and SCD-HeFT, higher NYHA class, lower LVEF, no beta-blocker therapy, and single chamber ICD (vs. dual chamber) were significant predictors of appropriate shocks.
| Original language | English |
|---|---|
| Pages (from-to) | 1345-1351 |
| Number of pages | 7 |
| Journal | Journal of Cardiovascular Electrophysiology |
| Volume | 28 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - Nov 1 2017 |
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Keywords
- implantable cardioverter defibrillator
- meta-analysis
- primary prevention
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
Cite this
Predicting appropriate shocks in patients with heart failure : Patient level meta-analysis from SCD-HeFT and MADIT II. / Zeitler, Emily P.; Al-Khatib, Sana M.; Friedman, Daniel J.; Han, Joo Yoon; Poole, Jeanne E.; Bardy, Gust H.; Bigger, J. Thomas; Buxton, Alfred E.; Moss, Arthur J.; Lee, Kerry L.; Dorian, Paul; Cappato, Riccardo; Kadish, Alan H.; Kudenchuk, Peter J.; Mark, Daniel B.; Inoue, Lurdes Y.T.; Sanders, Gillian D.
In: Journal of Cardiovascular Electrophysiology, Vol. 28, No. 11, 01.11.2017, p. 1345-1351.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Predicting appropriate shocks in patients with heart failure
T2 - Patient level meta-analysis from SCD-HeFT and MADIT II
AU - Zeitler, Emily P.
AU - Al-Khatib, Sana M.
AU - Friedman, Daniel J.
AU - Han, Joo Yoon
AU - Poole, Jeanne E.
AU - Bardy, Gust H.
AU - Bigger, J. Thomas
AU - Buxton, Alfred E.
AU - Moss, Arthur J.
AU - Lee, Kerry L.
AU - Dorian, Paul
AU - Cappato, Riccardo
AU - Kadish, Alan H.
AU - Kudenchuk, Peter J.
AU - Mark, Daniel B.
AU - Inoue, Lurdes Y.T.
AU - Sanders, Gillian D.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Background: No precise tools exist to predict appropriate shocks in patients with a primary prevention ICD. We sought to identify characteristics predictive of appropriate shocks in patients with a primary prevention implantable cardioverter defibrillator (ICD). Methods: Using patient-level data from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), we identified patients with any appropriate shock. Clinical and demographic variables were included in a logistic regression model to predict appropriate shocks. Results: There were 1,463 patients randomized to an ICD, and 285 (19%) had ≥1 appropriate shock over a median follow-up of 2.59 years. Compared with patients without appropriate ICD shocks, patients who received any appropriate shock tended to have more severe heart failure. In a multiple logistic regression model, predictors of appropriate shocks included NYHA class (NYHA II vs. I: OR 1.65, 95% CI 1.07–2.55; NYHA III vs. I: OR 1.74, 95% CI 1.10–2.76), lower LVEF (per 1% change) (OR 1.04, 95% CI 1.02–1.06), absence of beta-blocker therapy (OR 1.61, 95% CI 1.23–2.12), and single chamber ICD (OR 1.67, 95% CI 1.13–2.45). Conclusion: In this meta-analysis of patient level data from MADIT-II and SCD-HeFT, higher NYHA class, lower LVEF, no beta-blocker therapy, and single chamber ICD (vs. dual chamber) were significant predictors of appropriate shocks.
AB - Background: No precise tools exist to predict appropriate shocks in patients with a primary prevention ICD. We sought to identify characteristics predictive of appropriate shocks in patients with a primary prevention implantable cardioverter defibrillator (ICD). Methods: Using patient-level data from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), we identified patients with any appropriate shock. Clinical and demographic variables were included in a logistic regression model to predict appropriate shocks. Results: There were 1,463 patients randomized to an ICD, and 285 (19%) had ≥1 appropriate shock over a median follow-up of 2.59 years. Compared with patients without appropriate ICD shocks, patients who received any appropriate shock tended to have more severe heart failure. In a multiple logistic regression model, predictors of appropriate shocks included NYHA class (NYHA II vs. I: OR 1.65, 95% CI 1.07–2.55; NYHA III vs. I: OR 1.74, 95% CI 1.10–2.76), lower LVEF (per 1% change) (OR 1.04, 95% CI 1.02–1.06), absence of beta-blocker therapy (OR 1.61, 95% CI 1.23–2.12), and single chamber ICD (OR 1.67, 95% CI 1.13–2.45). Conclusion: In this meta-analysis of patient level data from MADIT-II and SCD-HeFT, higher NYHA class, lower LVEF, no beta-blocker therapy, and single chamber ICD (vs. dual chamber) were significant predictors of appropriate shocks.
KW - implantable cardioverter defibrillator
KW - meta-analysis
KW - primary prevention
UR - http://www.scopus.com/inward/record.url?scp=85033492192&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85033492192&partnerID=8YFLogxK
U2 - 10.1111/jce.13307
DO - 10.1111/jce.13307
M3 - Article
AN - SCOPUS:85033492192
VL - 28
SP - 1345
EP - 1351
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
SN - 1045-3873
IS - 11
ER -