Marital Status and Long-Term Outcomes in Mild Heart Failure Patients With an Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy With Defibrillator.
Aged
Bundle-Branch Block
/ therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy Devices
Cause of Death
Defibrillators, Implantable
Disease Progression
Female
Heart Failure
/ therapy
Humans
Kaplan-Meier Estimate
Male
Marital Status
/ statistics & numerical data
Middle Aged
Mortality
Proportional Hazards Models
Ventricular Dysfunction, Left
/ therapy
Journal
The American journal of cardiology
ISSN: 1879-1913
Titre abrégé: Am J Cardiol
Pays: United States
ID NLM: 0207277
Informations de publication
Date de publication:
15 04 2020
15 04 2020
Historique:
received:
11
11
2019
revised:
15
01
2020
accepted:
17
01
2020
pubmed:
24
2
2020
medline:
4
8
2020
entrez:
24
2
2020
Statut:
ppublish
Résumé
Married patients have been shown to have a lower risk for adverse cardiovascular outcomes. However, the risk of heart failure (HF) or death in married versus unmarried patients with left ventricular (LV) dysfunction and an implantable cardioverter defibrillator (ICD), and the effect of cardiac resynchronization therapy with defibrillator (CRT-D) are unknown. In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), in patients with left bundle branch block, we evaluated long-term clinical outcomes of all-cause mortality or HF events in married (including common law status) compared with unmarried (single/divorced/widowed) patients with CRT-D versus an ICD-only. There were 937 married patients and 344 unmarried patients with left bundle branch block. Multivariate analysis showed that married patients had a 54% lower risk of all-cause mortality (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.30 to 0.71, p <0.001) compared with the unmarried. However, the survival benefit associated with marital status was pronounced in ICD patients (HR 0.40, 95% CI 0.23 to 0.69, p <0.001) and attenuated in CRT-D patients (HR 0.74, 95% CI 0.51 to 1.06, p = 0.10), interaction (p = 0.07). Consistently, during the median follow-up of 5.6 years, in patients with ICD, married patients had a significantly lower incidence of death (24%) compared with unmarried patients (42%; p = 0.004), whereas the corresponding mortality rates in CRT-D patients were not significantly different (p = 0.814). In conclusion, during long-term follow-up of mild HF patients with LV dysfunction, married patients were at a significantly lower risk for death compared with those not married. The survival benefit associated with marital status was pronounced in patients implanted with an ICD and is attenuated in those implanted with a CRT-D device.
Identifiants
pubmed: 32088000
pii: S0002-9149(20)30052-7
doi: 10.1016/j.amjcard.2020.01.011
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1180-1186Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.