Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure : a propensity-matched analysis of the WARCEF trial

© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology..

AIMS: There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial.

METHODS AND RESULTS: We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131).

CONCLUSIONS: The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.

Media Type:

Electronic Article

Year of Publication:

2019

Contained In:

ESC heart failure - Vol. 6, No. 2 (2019), p. 297-307

Language:

English

Contributors:

Lee, Tetz C
Qian, Min
Mu, Lan
Di Tullio, Marco R
Graham, Susan
Mann, Douglas L
Nakanishi, Koki
Teerlink, John R
Lip, Gregory Y H
Freudenberger, Ronald S
Sacco, Ralph L
Mohr, Jay P
Labovitz, Arthur J
Ponikowski, Piotr
Lok, Dirk J
Estol, Conrado
Anker, Stefan D
Pullicino, Patrick M
Buchsbaum, Richard
Levin, Bruce
Thompson, John L P
Homma, Shunichi
Ye, Siqin
WARCEF Investigators

Links:

Volltext

Keywords:

*Defibrillators, Implantable
*Propensity Score
5Q7ZVV76EI
Aged
Anticoagulants
Aspirin
Cardiomyopathies
Cause of Death
Echocardiography
Female
Follow-Up Studies
Heart Failure
Heart Ventricles
Heart failure with reduced ejection fraction
Humans
Implantable cardioverter-defibrillator
Journal Article
Male
Middle Aged
Multicenter Study
Non-ischaemic cardiomyopathy
Platelet Aggregation Inhibitors
Propensity score matching
R16CO5Y76E
Radionuclide Ventriculography
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Retrospective Studies
Risk Factors
Stroke Volume
Survival Rate
United States
Ventricular Function, Left
Warfarin

Notes:

Date Completed 16.05.2019

Date Revised 09.01.2021

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1002/ehf2.12407

PMID:

30816013

PPN (Catalogue-ID):

NLM294937951