医学
植入式心律转复除颤器
心源性猝死
心力衰竭
危险系数
内科学
临床试验
死亡率
初级预防
倾向得分匹配
急诊医学
心脏病学
疾病
置信区间
作者
Aamir Ahmed,Angelo Auricchio,Suneet Mittal,Robert A. Pickett,Bruce L. Wilkoff,Luke D. Jacobsen,Anne M. Marti,Reece Holbrook,Dana Soderlund,Anne B. Curtis
标识
DOI:10.1016/j.jacep.2024.102334
摘要
Past clinical trials have shown the benefit of implantable cardioverter-defibrillators (ICDs) for reducing sudden cardiac death in at-risk patients. However, heart failure management and ICD technology have changed since these trials were first published. An updated assessment of ICD mortality benefit is needed.The purpose of this study was to compare mortality rates between patients with a primary prevention (PP) indication for an ICD who did or did not receive an ICD using a contemporary, real-world data set.Data was obtained from a large electronic health record data set covering patients in the United States from 2012 through 2020 who had a PP indication for an ICD and survived at least 1-year postindication.A total of 25,296 patients were identified as having a PP indication for ICD implantation, of which 2,118 (8.4%) were treated with an ICD within a year. Treated patients were younger than nontreated patients (63.4 years vs 66.1 years) with a smaller proportion of women (25.0% vs 36.7%). After 4-to-1 propensity matching, treated patients had similar clinical characteristics to nontreated patients. A Cox proportional hazard model estimated a 24.3% lower risk of all-cause mortality in patients when treated vs not treated with an ICD (HR: 0.757; CI: 0.678-0.835; P <0.001). There was no detectable difference in ICD benefit between patients with ischemic and nonischemic heart disease (P = 0.50).ICD treatment of patients with a PP indication is associated with improved mortality even in the context of evolving adjunctive HF treatment, consistent with earlier landmark trials.
科研通智能强力驱动
Strongly Powered by AbleSci AI