Efficacy of an implantable cardioverter-defibrillator in patients with diabetes and heart failure and reduced ejection fraction

Rørth, R., Dewan, P. , Kristensen, S. L., Jhund, P. S. , Petrie, M. C. , Køber, L. and McMurray, J. J.V. (2019) Efficacy of an implantable cardioverter-defibrillator in patients with diabetes and heart failure and reduced ejection fraction. Clinical Research in Cardiology, (doi:10.1007/s00392-019-01415-z) (PMID:30689020) (Early Online Publication)

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Abstract

Background: The effect of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure with reduced ejection fraction (HFrEF) and diabetes is not fully elucidated. Methods: We examined the effect of ICD therapy on sudden cardiac death, cardiovascular death and all-cause mortality, according to diabetes status at baseline in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). The outcomes were analyzed by use of cumulative incidence curves and Cox regressions models. Results: Of the 1676 patients randomized to an ICD or placebo, 540 (32%) had diabetes at baseline. Patients with diabetes were slightly older (61 vs 58 years) and were more often in NYHA class III (37% vs 28%). ICD therapy did not reduce the risk of sudden cardiac death in HFrEF patients with diabetes (HR = 0.85; 95% CI 0.52–1.40); even though these patients had a higher risk of sudden cardiac death compared to patients without diabetes (HR = 1.73 95% CI 1.22–2.47). By contrast, ICD therapy did reduce sudden cardiac death in HFrEF patients without diabetes (HR = 0.26; 95% CI 0.15–0.46); Pinteraction=0.002. The findings for cardiovascular and all-cause death were similar. Conclusion: ICD therapy did not reduce the risk of sudden cardiac death (or, as a consequence, all-cause death) in HFrEF patients with diabetes. Conversely, an ICD reduced the risk of sudden death in patients without diabetes, irrespective of etiology.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Roerth, Dr Rasmus and Dewan, Dr Pooja and Kristensen, Mr Soren Lund and Jhund, Dr Pardeep and Petrie, Professor Mark and McMurray, Professor John and Kober, Professor Lars
Authors: Rørth, R., Dewan, P., Kristensen, S. L., Jhund, P. S., Petrie, M. C., Køber, L., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Clinical Research in Cardiology
Publisher:Springer
ISSN:1861-0684
ISSN (Online):1861-0692
Published Online:28 January 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Clinical Research in Cardiology 2019
Publisher Policy:Reproduced under a Creative Commons License

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