Modeling defibrillation benefit for survival among cardiac resynchronization therapy defibrillator recipients.
Am Heart J
; 222: 93-104, 2020 04.
Article
em En
| MEDLINE
| ID: mdl-32032927
ABSTRACT
BACKGROUND:
Patients with heart failure having a low expected probability of arrhythmic death may not benefit from implantable cardioverter defibrillators (ICDs).OBJECTIVE:
The objective was to validate models to identify cardiac resynchronization therapy (CRT) candidates who may not require CRT devices with ICD functionality.METHODS:
Heart failure (HF) patients with CRT-Ds and non-CRT ICDs from the National Cardiovascular Data Registry and others with no device from 3 separate registries and 3 heart failure trials were analyzed using multivariable Cox proportional hazards regression for survival with the Seattle Heart Failure Model (SHFM; estimates overall mortality) and the Seattle Proportional Risk Model (SPRM; estimates proportional risk of arrhythmic death).RESULTS:
Among 60,185 patients (age 68.6⯱â¯11.3 years, 31.9% female) meeting CRT-D criteria, 38,348 had CRT-Ds, 11,389 had non-CRT ICDs, and 10,448 had no device. CRT-D patients had a prominent adjusted survival benefit (HR 0.52, 95% CI 0.50-0.55, Pâ¯<â¯.0001 versus no device). CRT-D patients with SHFM-predicted 4-year survival ≥81% (median) and a low SPRM-predicted probability of an arrhythmic mode of death ≤42% (median) had an absolute adjusted risk reduction attributable to ICD functionality of just 0.95%/year with the majority of survival benefit (70%) attributable to CRT pacing. In contrast, CRT-D patients with SHFM-predicted survivalCONCLUSIONS:
The SPRM and SHFM identified a quarter of real-world, primary prevention CRT-D patients with minimal benefit from ICD functionality. Further studies to evaluate CRT pacemakers in these low-risk CRT candidates are indicated.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Prevenção Primária
/
Sistema de Registros
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Morte Súbita Cardíaca
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Desfibriladores Implantáveis
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Medição de Risco
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Terapia de Ressincronização Cardíaca
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Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
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Humans
/
Male
País/Região como assunto:
Europa
Idioma:
En
Revista:
Am Heart J
Ano de publicação:
2020
Tipo de documento:
Article