Concurrent ICDs placement renders primary prevention among HF patients, reveals research

Previous clinical trials established the efficacy of ICDs in reducing sudden cardiac death among high-risk patients. However, since those studies, there have been notable advancements in heart failure (HF) treatment and ICD technology, necessitating an updated evaluation of ICD benefits.

The primary aim of this study was to compare mortality rates between patients with a primary prevention indication for an ICD who received the device and those who did not, using contemporary real-world data. The study analyzed data from a large electronic health record database of U.S. patients between 2012 and 2020. Included patients had a PP indication for ICD and survived at least one year post-indication.

The study findings were as follows:

• A total of 25,296 patients met the inclusion criteria. Among them, 2,118 (8.4%) received an ICD within a year of indication.

• The treated group was younger (average age 63.4 years) compared to the non-treated group (average age 66.1 years) and had a smaller proportion of women (25.0% vs 36.7%).

• After adjusting for clinical characteristics through 4-to-1 propensity matching, the study employed a Cox proportional hazard model to estimate the impact of ICD treatment on mortality.

• Patients treated with an ICD had a 24.3% lower risk of all-cause mortality compared to those who did not receive the device (HR: 0.757; 95% CI: 0.678-0.835; P < 0.001).

• There was no significant difference in ICD benefit between patients with ischemic and nonischemic heart disease (P = 0.50).

The absence of differential benefit between ischemic and nonischemic heart disease patients suggests a broad applicability of ICDs across different heart failure etiologies. ICD therapy for patients with a primary prevention indication is associated with a significant reduction in all-cause mortality.

Reference:

Ahmed, A., Auricchio, A., Mittal, S., Pickett, R. A., Wilkoff, B. L., Jacobsen, L. D., Marti, A. K., Holbrook, R. W., Soderlund, D. M., & Curtis, A. B. (2024). Mortality benefit among primary prevention implantable cardioverter-defibrillator recipients on contemporary heart failure treatment. JACC. Clinical Electrophysiology, 10(5), 916–926. https://doi.org/10.1016/j.jacep.2024.102334