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Modeling defibrillation benefit for survival among cardiac resynchronization therapy defibrillator recipients.


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?±?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, P?median had substantially more ICD-attributable benefit (absolute risk reduction of 2.6%/year combined; P?ConclusionsThe 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.

SUBMITTER: Bilchick KC 

PROVIDER: S-EPMC7814502 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Publications

Modeling defibrillation benefit for survival among cardiac resynchronization therapy defibrillator recipients.

Bilchick Kenneth C KC   Wang Yongfei Y   Curtis Jeptha P JP   Cheng Alan A   Dharmarajan Kumar K   Shadman Ramin R   Dardas Todd F TF   Anand Inder I   Lund Lars H LH   Dahlström Ulf U   Sartipy Ulrik U   Maggioni Aldo A   O'Connor Christopher C   Levy Wayne C WC  

American heart journal 20191227


<h4>Background</h4>Patients with heart failure having a low expected probability of arrhythmic death may not benefit from implantable cardioverter defibrillators (ICDs).<h4>Objective</h4>The objective was to validate models to identify cardiac resynchronization therapy (CRT) candidates who may not require CRT devices with ICD functionality.<h4>Methods</h4>Heart failure (HF) patients with CRT-Ds and non-CRT ICDs from the National Cardiovascular Data Registry and others with no device from 3 separ  ...[more]

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