Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Wearable Cardioverter-Defibrillator Use After MI

N Engl J Med; 2018 Sep 27; Olgin, et al

A wearable cardioverter-defibrillator did not lead to significantly lower rate of arrhythmic death among patients with a recent myocardial infarction (MI) and an ejection fraction of ≤35%, a recent study found. Patients with acute MI and an ejection fraction of ≤35% were randomly assigned (2:1) to receive a wearable cardioverter-defibrillator plus guideline-directed therapy (device group) or to receive only guideline-directed therapy (control group). The primary outcome was the composite of sudden death or death from ventricular tachyarrhythmia at 90 days (arrhythmic death). Secondary outcomes included death from any cause and nonarrhythmic death. Among the details:

  • Of 2,302 study participants, 1,524 were randomly assigned to the device group and 778 to the control group.
  • Device group participants wore the device for a median of 18.0 hours/day.
  • Arrhythmic death occurred in 1.6% of participants in the device group vs 2.4% in the control group (relative risk [RR], 0.67).
  • Death from any cause occurred in 3.1% of those in the device group vs 4.9% in the control group (RR, 0.64) and nonarrhythmic death in 1.4% and 2.2%, respectively, (RR, 0.63).


Olgin JE, Pletcher MJ, Vittinghoff E, et al. Wearable cardioverter-defibrillator after myocardial infarction. N Engl J Med. 2018;379:1205-1215. doi:10.1056/NEJMoa1800781.