Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings

Abstract

BackgroundThe efficacy of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System (SUS).MethodsAll patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto’s test. Prognostic factors were selected using Cox’s models.ResultsThere were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas’ heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation (5.3%) than those undergoing transvenous implantation (1.6%) (p = 0.02).ConclusionsThe results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.

Prognosis Determinants after Cardioverter-Defibrillators Implantation in Brazil

“…In our study, Chagas heart disease patients did not have a worse prognosis when compared to those with ischemic heart disease, 2 similarly to another study recently published in Arquivos Brasileiros de Cardiologia. 3 …”

“…2 It would be interesting to know the magnitude of re-interventions in the short period of follow-up of the single-center registry and the possible impacts of implantation techniques in the outcomes.…”

“…We have recently published the results of short, medium, and long term follow-ups of all ICD and CRT-ICD implantations funded by The Brazilian Unified Healthcare System (SUS) in all of Brazil, between 2001 and 2007, including 3,295 ICD implantations in 85 hospitals and 681 CRT-ICD implantations in 50 hospitals. 2 …”

Medium-term outcomes of 78,808 patients after heart valve surgery in a middle-income country: a nationwide population-based study

“…These measures were obtained by probabilistic record linkage [ 17 ] using the SIH and SIM databases. The linkage method applied showed 90.6% sensitivity and 100% specificity [ 18 ] and was used in a prior study [ 19 ].…”

Long-term follow-up of implantable cardioverter-defibrillators in children: Indications and outcomes

“…The implementation of ICD therapy has significantly decreased the number of sudden cardiac deaths (SCD) in the adult population. [1][2][3] According to the American Heart Association (AHA) and American College of Cardiology (ACC) recommendations, the secondary prevention indications for ICD therapy are the same in children as in adults. The main indications for ICD implantation in the pediatric population are primary electrical heart disease (PED), cardiomyopathy (CMP), congenital heart defect (CHD) post-surgical correction, ventricular tachycardia (VT), and idiopathic ventricular fibrillation (VF) in patients with an anatomically normal heart.…”