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Survival higher with ICD in patients with LVEF of 30%-35%


 

FROM JAMA

Prophylactic implantable cardioverter-defibrillator use was associated with improved 3-year survival in Medicare beneficiaries with heart failure and a left ventricular ejection fraction of 30%-35% and in those with LVEF less than 30%, compared with no prophylactic ICD use in comparable patients in a retrospective cohort study.

All-cause mortality at 3 years in 408 patients with LVEF of 30% -35% who received a prophylactic ICD was 51.4%, compared with 55% in 408 matched controls without an ICD (hazard ratio, 0.83). The all-cause mortality rates at 3 years in 1,088 patients with LVEF of less than 30% was 45% in those with a prophylactic ICD vs. 57.6% in 1,088 matched controls without an ICD (HR, 0.72), Dr. Sana M. Al-Khatib of Duke University, Durham, N.C., and her colleagues reported in the June 4 issue of JAMA.

Study subjects were Medicare beneficiaries in the National Cardiovascular Data Registry ICD registry during 2006-2007, and similar patients in the Get With the Guidelines-Heart Failure database during 2005-2009 (JAMA 2014;311:2209-15).

Prior studies of prophylactic ICD use have included only a minority of patients with LVEF of 30%-35%; the current findings demonstrate a "clearly significant" benefit in this population and support guideline recommendations calling for prophylactic ICD use in eligible patients with an LVEF of 35% or less, the investigators concluded.

This study was funded by a National Heart, Lung, and Blood Institute grant. Dr. Al-Khatib reported having no disclosures. Detailed disclosures for several of the other study authors are available with the full text of the article at jama.com.

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