Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death: A Systematic Review and Meta-Analysis.
death
meta-analysis
shock
systematic review
wearable cardioverter-defibrillator
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
23
08
2018
revised:
15
11
2018
accepted:
20
11
2018
entrez:
21
2
2019
pubmed:
21
2
2019
medline:
31
3
2020
Statut:
ppublish
Résumé
This study sought to synthesize the available evidence on the use of the wearable cardioverter-defibrillator (WCD). Observational WCD studies for the prevention of sudden cardiac death have provided conflicting data. The VEST (Vest Prevention of Early Sudden Death) trial was the first randomized controlled trial (RCT) showing no reduction in sudden cardiac death as compared to medical therapy only. We searched PubMed, EMBASE, and Google Scholar for studies reporting on the outcomes of patients wearing WCDs from January 1, 2001, through March 20, 2018. Rates of appropriate and inappropriate WCD therapies were pooled. Estimates were derived using DerSimonian and Laird's method. Twenty-eight studies were included (N = 33,242; 27 observational, 1 RCT-WCD arm). The incidence of appropriate WCD therapy was 5 per 100 persons over 3 months (95% confidence interval [CI]: 3.0 to 6.0, I The rate of appropriately treated WCD patients over 3 months of follow-up was substantial; higher in-observational studies as compared with the VEST trial. There was significant heterogeneity. More RCTs are needed to justify continued use of WCD in primary prevention.
Sections du résumé
OBJECTIVES
This study sought to synthesize the available evidence on the use of the wearable cardioverter-defibrillator (WCD).
BACKGROUND
Observational WCD studies for the prevention of sudden cardiac death have provided conflicting data. The VEST (Vest Prevention of Early Sudden Death) trial was the first randomized controlled trial (RCT) showing no reduction in sudden cardiac death as compared to medical therapy only.
METHODS
We searched PubMed, EMBASE, and Google Scholar for studies reporting on the outcomes of patients wearing WCDs from January 1, 2001, through March 20, 2018. Rates of appropriate and inappropriate WCD therapies were pooled. Estimates were derived using DerSimonian and Laird's method.
RESULTS
Twenty-eight studies were included (N = 33,242; 27 observational, 1 RCT-WCD arm). The incidence of appropriate WCD therapy was 5 per 100 persons over 3 months (95% confidence interval [CI]: 3.0 to 6.0, I
CONCLUSIONS
The rate of appropriately treated WCD patients over 3 months of follow-up was substantial; higher in-observational studies as compared with the VEST trial. There was significant heterogeneity. More RCTs are needed to justify continued use of WCD in primary prevention.
Identifiants
pubmed: 30784684
pii: S2405-500X(18)30961-7
doi: 10.1016/j.jacep.2018.11.011
pmc: PMC6383782
mid: NIHMS1514424
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
152-161Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL129964
Pays : United States
Informations de copyright
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Références
N Engl J Med. 2018 Sep 27;379(13):1205-1215
pubmed: 30280654
J Am Coll Cardiol. 2013 Nov 19;62(21):2000-2007
pubmed: 23916930
J Cardiol. 2017 Jan;69(1):359-363
pubmed: 27595899
J Electrocardiol. 2017 Sep - Oct;50(5):603-609
pubmed: 28499628
J Interv Card Electrophysiol. 2017 Jan;48(1):11-19
pubmed: 27752809
J Card Fail. 2012 Jan;18(1):21-7
pubmed: 22196837
N Engl J Med. 2016 Sep 29;375(13):1221-30
pubmed: 27571011
J Arrhythm. 2015 Oct;31(5):293-5
pubmed: 26550085
Heart Lung Circ. 2016 Feb;25(2):155-9
pubmed: 26361817
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
Pacing Clin Electrophysiol. 2004 Jan;27(1):4-9
pubmed: 14720148
Indian Pacing Electrophysiol J. 2017 May - Jun;17(3):65-69
pubmed: 29072998
Circulation. 2016 Aug 30;134(9):635-43
pubmed: 27458236
J Am Coll Cardiol. 2010 Jul 13;56(3):194-203
pubmed: 20620738
JACC Clin Electrophysiol. 2018 Feb;4(2):231-239
pubmed: 29749943
Pacing Clin Electrophysiol. 2014 May;37(5):562-8
pubmed: 24762055
N Engl J Med. 2009 Oct 8;361(15):1427-36
pubmed: 19812399
J Am Heart Assoc. 2017 Jan 17;6(1):
pubmed: 28096098
BMJ. 1997 Sep 13;315(7109):629-34
pubmed: 9310563
Can J Cardiol. 2016 Oct;32(10):1247.e1-1247.e6
pubmed: 26975224
J Heart Lung Transplant. 2015 Oct;34(10):1305-9
pubmed: 26094085
Clin Cardiol. 2017 Aug;40(8):586-590
pubmed: 28333373
J Cardiovasc Electrophysiol. 2017 Jul;28(7):778-784
pubmed: 28429542
JAMA. 2000 Apr 19;283(15):2008-12
pubmed: 10789670
J Am Coll Cardiol. 2018 Oct 2;72(14):e91-e220
pubmed: 29097296
Clin Res Cardiol. 2017 Apr;106(4):300-306
pubmed: 27888304
Circ Arrhythm Electrophysiol. 2013 Feb;6(1):117-28
pubmed: 23275233
JACC Clin Electrophysiol. 2017 Mar;3(3):243-250
pubmed: 29759518
Circulation. 2015 Oct 27;132(17):1613-9
pubmed: 26316618
J Am Coll Cardiol. 2015 Dec 15;66(23):2607-2613
pubmed: 26670060
Neth Heart J. 2017 May;25(5):312-317
pubmed: 28188473
Heart Lung Circ. 2018 Aug;27(8):984-988
pubmed: 28969980
N Engl J Med. 2004 Dec 9;351(24):2481-8
pubmed: 15590950
Clin Res Cardiol. 2018 Jan;107(1):70-75
pubmed: 28993851
BMC Cardiovasc Disord. 2012 Dec 12;12:123
pubmed: 23234574