Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients

Abstract

Background The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy. Methods We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs. Results Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36–1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56–2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35–2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39–0.79). Conclusion Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited.

Implantable Cardioverter Defibrillator Tachycardia Therapies: Past, Present and Future Directions

“…A pooled analysis of chronic kidney disease (CKD) patients who underwent CRT implantation from the MADIT-CRT and RAID trial showed that the patients with more advanced CKD experienced a high non-arrhythmic mortality rate and a lower rate of ventricular arrhythmias, and did not appear to attain the same degree of benefit from a primary prevention ICD [ 77 ]. A retrospective analysis of 3535 diabetic patients in the EU-CERT-ICD registry [ 78 ] and a large meta-analysis of 162,780 patients, comparing diabetic and non-diabetic patients with ICDs [ 79 ], suggested that, as a group, they received attenuated or no benefit from prophylactic ICDs. Prospective randomized data in these groups of patients are lacking.…”

Cognitive impairment is associated with BDNF‐TrkB signaling mediating synaptic damage and reduction of amino acid neurotransmitters in heart failure

“…Heart failure (HF) is a complex multifaceted syndrome of organic heart disease that occurs in the end stage. 1 It is a significant health care concern, affecting an estimated 30-50 million patients worldwide. 2 Importantly, cognitive impairment (CI) is a commonly co-occurring chronic condition among patients with HF, often accompanied by memory impairment, slower information processing, and impaired executive function.…”

“…Heart failure (HF) is a complex multifaceted syndrome of organic heart disease that occurs in the end stage 1 . It is a significant health care concern, affecting an estimated 30–50 million patients worldwide 2 .…”