Acompanhamento a longo prazo de pacientes com indicação de desfibrilador implantável como prevenção primária de morte súbita

Hadid, Claudio; Avellana, Patricia; Gomez, Claudia Fernández; Visser, Miguel; Prieto, Noemí

doi:10.1590/s0066-782x2008000500006

Cited by 3 publications

(1 citation statement)

References 33 publications

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“…In another study, in fact, subgroup analysis of data from 459 patients randomly assigned to standard therapy or standard therapy plus an ICD revealed that LVEF ≥20%, male gender, and NYHA Class III but not Class I or II, were significantly associated with improved survival [13]. A Brazilian study compared 102 patients who did not receive an ICD to patients in the placebo arm of another major primary prevention study, SCD-HeFT, and found that the mortality rates were similar between the 2 groups, causing them to conclude that their patients were similar, and may benefit from ICD therapy if economic constraints could be removed [14]. Likewise, our patients shared several similarities with the RCT patients; for example age, gender, proportion of patients with ischemic cardiomyopathy, and distribution among NYHA functional classes was similar to those in the 12 RCTs included in the systematic review by Ezekowitz et al [4].…”

Section: Discussionmentioning

confidence: 99%

Implantable Cardioverter Defibrillator Therapy: A Single Center Experience in Saudi Arabia

Hersi¹

2010

TOCMJ

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Introduction:Internal Cardioverter Defibrillators (ICD) has been shown to decrease mortality in patients such as those with structural heart disease or at high risk of sudden cardiac death. To date there is no data regarding the clinical features, and outcomes of ICD patients in Saudi Arabia. Accordingly, we explored the clinical features and outcomes of ICD therapy among Saudis.Methods:Patients who had ICD implantation in King Khalid University Hospital from November 2007 until January 2010 were enrolled.Results:One hundred and eight ICD were implanted between November 2007 and February 2010. The mean age was 58.6±13.2 years. The majority were male 94 (87%), the rate of Diabetes Mellitus (DM) was 58.3%, Hypertension (HTN) was 61.1%, and 63% were smokers. The mean ejection fraction (EF) was 24.5%. Of the 108 patient 90(83.3%) had ICD insertion for primary prevention and 18(16.7%) for secondary prevention. Of the 90 patients who ICD for primary prevention 62 (57.4%) had ischemic cardiomyopathy, 39(36.1%) had dilated cardiomyopathy and 7 (6.5%) had channelopathy. Over a mean follow-up of 18 months 4 (3.7%) died. Conclusions:Our study describes for the first time patients characteristic and outcomes for ICD therapy in Saudi Arabia. Our patients are younger and have higher prevalence of risk factors that those in Western countries.

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Section: Discussionmentioning

confidence: 99%

Implantable Cardioverter Defibrillator Therapy: A Single Center Experience in Saudi Arabia

Hersi¹

2010

TOCMJ

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Cardioversor-desfibrilador na prevenção primária de morte súbita: para todos ou para poucos?

Zimerman

2008

Arq. Bras. Cardiol.

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The implantable cardioverter-defibrillators (ICD) have been used for more than two decades to prevent sudden death. Initially recommended for secondary prevention, currently their most common indication is the primary prevention.A recent US report showed that, of the 108,341 implants carried in 2006, 85,823 (79.2%) were for primary prevention and only 22,518 (20.8%) were for secondary prevention 1 . Several clinical trials have sought to define which patients ought to have this form of treatment. The most recent and largest of these trials is the "Sudden Cardiac Death in Heart Failure" (SCD-Heft) 2 , which followed 2,521 patients with CHF Functional Class II-III and EF <35% in 3 groups (placebo, amiodarone and ICD implant) for a mean follow-up of 45.5 months. This study showed a decrease in the total mortality of the group with ICD, with 23% decrease in the relative risk in the ICD group and no benefit with amiodarone use.Considering that these clinical trials were carried out basically in developed countries, in an environment that is different from the Brazilian one, the applicability of these data is frequently questioned. The present study 3 sought to validate the results for the Brazilian population by comparing the patients from the SCD-Heft to those that met the inclusion criteria of the SCD-Heft and were from a Heart Failure Outpatient Clinic of a hospital in our country. The comparison between the groups showed small differences: the percentage of ischemic patients is slightly higher (63 vs. 53%, p=0.05) and the use of digoxin is lower among the patients of the present study (35 vs. 70%; p<0.001). Regarding the digoxin, no alterations in mortality are expected with its use, which makes this possible confounding factor less important. The slightly higher percentage of ischemic patients might have significance in terms of mortality, as these patients usually present higher rates than the non-ischemic ones; however, that was not observed.The most important data from the point of view of alteration in mortality, such as ejection fraction and the use of beta-blockers and ACE inhibitors, are similar between the two studies. In the SCD-Heft, the benefit observed after the ICD implant occurred exclusively in patients with NYHA Functional Class II, which represented 70% of the total. This percentage was 67% in the present study, supporting the similarity between the populations. The conclusion that can be reached is that patients followed at the CHF outpatient clinic in our country are similar to the randomized ones in the SCD-Heft, indicating that the results of this clinical trial can be applied to our country.However, another much discussed issue regarding the implant of the ICD in our country is the cost-effectiveness. The authors of the present study suggest that this therapy is not regularly used due to the economic impact that it would generate in our health system. This discussion is not a recent one and it is also present in developed countries [4][5][6]

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Assistência circulatória mecânica: uma grande lacuna na cirurgia cardíaca brasileira

Moreira

Benício

2010

Rev Bras Cir Cardiovasc

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Acompanhamento a longo prazo de pacientes com indicação de desfibrilador implantável como prevenção primária de morte súbita

Cited by 3 publications

References 33 publications

Implantable Cardioverter Defibrillator Therapy: A Single Center Experience in Saudi Arabia

Implantable Cardioverter Defibrillator Therapy: A Single Center Experience in Saudi Arabia

Cardioversor-desfibrilador na prevenção primária de morte súbita: para todos ou para poucos?

Assistência circulatória mecânica: uma grande lacuna na cirurgia cardíaca brasileira

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