ICD Implantation in Patients with Nonischemic Heart Failure

Fauchier, L; Bisson, Arnaud; Clémenty, Nicolas

doi:10.1056/nejmc1614441

Cited by 8 publications

(1 citation statement)

References 17 publications

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“…4 Consequently, a recent consensus report from the Heart Failure Association of the European Society of Cardiology stated that it may be acceptable to abstain from ICD implantation in patients with nonischemic heart failure and reduced left ventricular ejection fraction age >70 years. 5 The current recommendation of primary-prevention ICD implantation in patients with nonischemic heart failure has been questioned, 6,7 especially in light of the substantial evolvement in the management of heart failure since the early trials on which the current recommendations are based. [8][9][10] Findings from recent registry-based observational studies 11,12 and meta-analyses that included the results from DANISH [13][14][15] supported current guideline recommendations, whereas some newer observational studies 16 and post hoc analyses 17 supported the findings of DANISH.…”

Section: Yafasova Et Almentioning

confidence: 99%

Long-Term Follow-Up of DANISH (The Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality)

et al. 2022

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Background: The Danish Study to Assess the Efficacy of Implantable Cardioverter-Defibrillators (ICDs) in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) found that primary-prevention ICD implantation was not associated with an overall survival benefit in patients with non-ischemic systolic heart failure during a median follow-up of 5.6 years, though there was a beneficial effect on all-cause mortality in patients ≤70 years. This study presents an additional four years of follow-up data from DANISH. Methods: In DANISH, 556 patients with non-ischemic systolic heart failure were randomized to receive an ICD and 560 to receive usual clinical care and followed until June 30, 2016. In this long-term follow-up study, patients were followed until May 18, 2020. Analyses were conducted for the overall population and according to age (≤70 and >70 years). Results: During a median follow-up of 9.5 years (25 th -75 th percentile, 7.9-10.9 years), 208/556 patients (37%) in the ICD group and 226/560 patients (40%) in the control group died. Compared with the control group, the ICD group did not have significantly lower all-cause mortality (HR 0.89 [95%CI,0.74-1.08]; P=0.24). In patients ≤70 years (n=829), all-cause mortality was lower in the ICD group than the control group (117/389 [30%] vs 158/440 [36%]; HR 0.78 [95%CI,0.61-0.99]; P=0.04), whereas in patients >70 years (n=287), all-cause mortality was not significantly different between the ICD and control group (91/167 [54%] vs 68/120 [57%]; HR 0.92 [95%CI,0.67-1.28]; P=0.75). Cardiovascular death showed similar trends (overall, 147/556 [26%] vs 164/560 [29%], HR 0.87 [95%CI,0,70-1.09], P=0.20; ≤70 years, 87/389 [22%] vs 122/440 [28%], HR 0.75 [95%CI,0.57-0.98], P=0.04; >70 years, 60/167 [36%] vs 42/120 [35%], HR 0.97 [95%CI,0.65-1.45], P=0.91). The ICD group had a significantly lower incidence of sudden cardiovascular death in the overall population (35/556 [6%] vs 57/560 [10%]; HR 0.60 [95%CI,0.40-0.92]; P=0.02) and in patients ≤70 years (19/389 [5%] vs 49/440 [11%]; HR 0.42 [95%CI,0.24-0.71]; P=0.0008), but not in patients >70 years (16/167 [10%] vs 8/120 [7%]; HR 1.34 [95%CI,0.56-3.19]; P=0.39). Conclusions: During a median follow-up of 9.5 years, ICD implantation did not provide an overall survival benefit in patients with non-ischemic systolic heart failure. In patients ≤70 years, ICD implantation was associated with a lower incidence of all-cause mortality, cardiovascular death, and sudden cardiovascular death. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945.

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Section: Yafasova Et Almentioning

confidence: 99%

Long-Term Follow-Up of DANISH (The Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality)

et al. 2022

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Updates in heart failure: what last year brought to us

et al. 2018

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EpidemiologyHeart failure (HF) is common, and HF with preserved ejection fraction (HFpEF) has become its most frequent clinical presentation because of ageing of the population and decreasing prevalence of coronary artery disease (CAD). 1,2 An analysis of all studies using echocardiography to estimate the prevalence of cardiac dysfunction in subjects aged ≥60 years showed a median prevalence of 36.0% (range 15.8-52.8%) and 5.5% (range 3.3-9.2%) for 'isolated' left ventricular (LV) diastolic dysfunction and LV systolic dysfunction, respectively, and a median prevalence of 4.9% (range 3.8-7.4%) and 3.3% (range 2.4-5.8%) for symptomatic HFpEF and HF with reduced ejection fraction (HFrEF).

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Should Primary Prevention ICDs Still Be Placed in Patients with Non-ischemic Cardiomyopathy? A Review of the Evidence

2018

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Despite significant benefits of GDMT and CRT, current evidence is derived from ICD trials that rely predominantly on reduced left ventricular ejection fraction alone (LVEF). The majority of patients with sudden cardiac death (SCD) have LVEF > 30% indicating that LVEF by itself is an inadequate predictor of SCD. The Danish study to assess the efficacy of ICD in patients with non-ischemic systolic heart failure on mortality (DANISH) highlights the importance of better risk stratifying NICM patients for ICD implantation. Assessment of life expectancy, comorbidities, presence of advanced heart failure, etiology of NICM, and the presence of myocardial fibrosis can help risk stratify ICD beyond LVEF. Genetics and biomarkers can be of further assistance in risk stratification.

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ICD Implantation in Patients with Nonischemic Heart Failure

Cited by 8 publications

References 17 publications

Long-Term Follow-Up of DANISH (The Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality)

Long-Term Follow-Up of DANISH (The Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality)

Updates in heart failure: what last year brought to us

Should Primary Prevention ICDs Still Be Placed in Patients with Non-ischemic Cardiomyopathy? A Review of the Evidence

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