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Long-term ICD survival more evident in patients with ischaemic HF, NYHA functional class II

2 days ago
The implantable cardioverter defibrillator (ICD) is a small device implanted under the skin in the chest, to help control life-threatening arrhythmias.

Heterogenous treatment-related patterns of long-term survival with implantable cardioverter defibrillator (ICD) therapy have been observed among patients who participated in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) over 11 years of follow-up, with the benefit most apparent for those with ischaemic heart failure (HF) and those with New York Heart Association (NYHA) functional class II symptoms at trial enrolment.

Between 2010 and 2011, the authors analysed mortality outcomes for the 1,855 patients alive at the end of SCD-HeFT and combined these data with the 666 deaths from the original study to compare long-term outcomes overall and for key prespecified subgroups.

Over a median (25th to 75th percentiles) follow-up of 11.0 years, overall survival benefit favoured the ICD group compared with the placebo group (hazard ratio [HR], 0.87, 95 percent confidence interval [CI], 0.76–0.98; p=0.028) in intention-to-treat analysis. The ICD benefit attenuated after 6 years (pinteraction=0.0015) when treatment benefit was analysed as a function of time from randomization.

In subgroup analysis, ICD benefit in the long term varied depending on the HF aetiology and NYHA functional class: ischaemic HF (HR, 0.81, 95 percent CI, 0.69–0.95; p=0.009); nonischaemic HF (HR, 0.97, 95 percent CI, 0.79–1.20; p=0.802); NYHA functional class II (HR, 0.76, 95 percent CI, 0.65–0.90; p=0.001); NYHA functional class III (HR, 1.06, 95 percent CI, 0.86–1.31; p=0.575).

The SCD-HeFT randomly assigned 2,521 patients with moderate HF to amiodarone, placebo drug, or ICD therapy, with follow-up ending on 31 October 2003. Over a median follow-up of 45.5 months, amiodarone showed no effect on survival as compared with placebo, but ICD led to a 23-percent reduction in all-cause mortality.

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Most Read Articles
Elvira Manzano, 13 Apr 2020
A gout drug that’s been around for years reduced the risk of ischaemic cardiovascular (CV) events when given at a low dose in patients who had myocardial infarction (MI) and was cost-effective, an analysis of the COLCOT* trial has shown.
Pearl Toh, 23 Apr 2020
Taking ticagrelor alone — and dropping aspirin — after 3 months of DAPT* post-PCI** significantly reduced bleeding events without increasing the risk of ischaemic adverse events compared with continuing a DAPT of ticagrelor plus aspirin, the TICO*** trial has shown.
Roshini Claire Anthony, 17 Jul 2020

Icosapent ethyl may reduce the risk of cardiovascular (CV) events in patients with diabetes mellitus (DM) taking statins, according to findings of REDUCE-IT DIABETES presented at ADA 2020.

Elaine Soliven, 12 Apr 2019
The use of catheter ablation as first-line treatment reduces the number of premature ventricular complexes (PVCs) in a paediatric population, according to a study presented at EHRA 2019.