Efficacy of an implantable cardioverter-defibrillator in patients with diabetes and heart failure and reduced ejection fraction.
Aged
Amiodarone
/ administration & dosage
Cause of Death
/ trends
Death, Sudden, Cardiac
/ prevention & control
Defibrillators, Implantable
Diabetes Mellitus
/ epidemiology
Dose-Response Relationship, Drug
Female
Heart Failure
/ epidemiology
Humans
Incidence
Male
Middle Aged
Risk Factors
Stroke Volume
/ physiology
Survival Rate
/ trends
Treatment Outcome
United Kingdom
/ epidemiology
Vasodilator Agents
/ administration & dosage
Diabetes
Heart failure with reduced ejection fraction
Implantable cardioverter-defibrillator
Sudden cardiac death
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
26
11
2018
accepted:
17
01
2019
pubmed:
29
1
2019
medline:
7
1
2020
entrez:
29
1
2019
Statut:
ppublish
Résumé
The effect of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure with reduced ejection fraction (HFrEF) and diabetes is not fully elucidated. We examined the effect of ICD therapy on sudden cardiac death, cardiovascular death and all-cause mortality, according to diabetes status at baseline in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). The outcomes were analyzed by use of cumulative incidence curves and Cox regressions models. Of the 1676 patients randomized to an ICD or placebo, 540 (32%) had diabetes at baseline. Patients with diabetes were slightly older (61 vs 58 years) and were more often in NYHA class III (37% vs 28%). ICD therapy did not reduce the risk of sudden cardiac death in HFrEF patients with diabetes (HR = 0.85; 95% CI 0.52-1.40); even though these patients had a higher risk of sudden cardiac death compared to patients without diabetes (HR = 1.73 95% CI 1.22-2.47). By contrast, ICD therapy did reduce sudden cardiac death in HFrEF patients without diabetes (HR = 0.26; 95% CI 0.15-0.46); P ICD therapy did not reduce the risk of sudden cardiac death (or, as a consequence, all-cause death) in HFrEF patients with diabetes. Conversely, an ICD reduced the risk of sudden death in patients without diabetes, irrespective of etiology.
Sections du résumé
BACKGROUND
BACKGROUND
The effect of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure with reduced ejection fraction (HFrEF) and diabetes is not fully elucidated.
METHODS
METHODS
We examined the effect of ICD therapy on sudden cardiac death, cardiovascular death and all-cause mortality, according to diabetes status at baseline in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). The outcomes were analyzed by use of cumulative incidence curves and Cox regressions models.
RESULTS
RESULTS
Of the 1676 patients randomized to an ICD or placebo, 540 (32%) had diabetes at baseline. Patients with diabetes were slightly older (61 vs 58 years) and were more often in NYHA class III (37% vs 28%). ICD therapy did not reduce the risk of sudden cardiac death in HFrEF patients with diabetes (HR = 0.85; 95% CI 0.52-1.40); even though these patients had a higher risk of sudden cardiac death compared to patients without diabetes (HR = 1.73 95% CI 1.22-2.47). By contrast, ICD therapy did reduce sudden cardiac death in HFrEF patients without diabetes (HR = 0.26; 95% CI 0.15-0.46); P
CONCLUSION
CONCLUSIONS
ICD therapy did not reduce the risk of sudden cardiac death (or, as a consequence, all-cause death) in HFrEF patients with diabetes. Conversely, an ICD reduced the risk of sudden death in patients without diabetes, irrespective of etiology.
Identifiants
pubmed: 30689020
doi: 10.1007/s00392-019-01415-z
pii: 10.1007/s00392-019-01415-z
pmc: PMC6652172
doi:
Substances chimiques
Vasodilator Agents
0
Amiodarone
N3RQ532IUT
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
868-877Commentaires et corrections
Type : ErratumIn
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