Survival benefit of primary prevention implantable cardioverter-defibrillator/cardiac resynchronization therapy with a defibrillator: Analysis of the Japan cardiac device treatment registry and Japanese cardiac registry of heart failure in cardiology
Corresponding Author
Hisashi Yokoshiki MD, PhD
Department of Cardiovascular Medicine, Sapporo City General Hospital, Sapporo, Japan
Correspondence
Hisashi Yokoshiki, Department of Cardiovascular Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-ku, Sapporo 060-8604, Japan.
Email: [email protected]
Search for more papers by this authorMasaya Watanabe MD, PhD
Department of Cardiovascular Medicine, Hokko Memorial Hospital, Sapporo, Japan
Search for more papers by this authorSanae Hamaguchi MD, PhD
Department of Cardiovascular Medicine, Sapporo City General Hospital, Sapporo, Japan
Search for more papers by this authorHiroyuki Tsutsui MD, PhD
School of Medicine and Graduate School, International University of Health and Welfare, Otawara, Japan
Search for more papers by this authorAkihiko Shimizu MD, PhD
UBE Kohsan Central Hospital, Ube, Japan
Search for more papers by this authorTakeshi Mitsuhashi MD, PhD
Department of Cardiovascular Medicine, Hoshi General Hospital, Koriyama, Japan
Search for more papers by this authorKohei Ishibashi MD, PhD
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
Search for more papers by this authorTomoyuki Kabutoya MD, PhD
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
Search for more papers by this authorYasuhiro Yoshiga MD, PhD
Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
Search for more papers by this authorYusuke Kondo MD, PhD
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Search for more papers by this authorTaro Temma MD, PhD
Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
Search for more papers by this authorMasahiko Takagi MD, PhD
Division of Cardiac Arrhythmia, Kansai Medical University Medical Centre, Moriguchi, Japan
Search for more papers by this authorHiroshi Tada MD, PhD
Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
Search for more papers by this authorCorresponding Author
Hisashi Yokoshiki MD, PhD
Department of Cardiovascular Medicine, Sapporo City General Hospital, Sapporo, Japan
Correspondence
Hisashi Yokoshiki, Department of Cardiovascular Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-ku, Sapporo 060-8604, Japan.
Email: [email protected]
Search for more papers by this authorMasaya Watanabe MD, PhD
Department of Cardiovascular Medicine, Hokko Memorial Hospital, Sapporo, Japan
Search for more papers by this authorSanae Hamaguchi MD, PhD
Department of Cardiovascular Medicine, Sapporo City General Hospital, Sapporo, Japan
Search for more papers by this authorHiroyuki Tsutsui MD, PhD
School of Medicine and Graduate School, International University of Health and Welfare, Otawara, Japan
Search for more papers by this authorAkihiko Shimizu MD, PhD
UBE Kohsan Central Hospital, Ube, Japan
Search for more papers by this authorTakeshi Mitsuhashi MD, PhD
Department of Cardiovascular Medicine, Hoshi General Hospital, Koriyama, Japan
Search for more papers by this authorKohei Ishibashi MD, PhD
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
Search for more papers by this authorTomoyuki Kabutoya MD, PhD
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
Search for more papers by this authorYasuhiro Yoshiga MD, PhD
Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
Search for more papers by this authorYusuke Kondo MD, PhD
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Search for more papers by this authorTaro Temma MD, PhD
Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
Search for more papers by this authorMasahiko Takagi MD, PhD
Division of Cardiac Arrhythmia, Kansai Medical University Medical Centre, Moriguchi, Japan
Search for more papers by this authorHiroshi Tada MD, PhD
Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
Search for more papers by this authorAbstract
Background
Evidence supporting the benefit from primary prevention implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy with a defibrillator (CRT-D) for heart failure with reduced ejection fraction (HFrEF) is scarce in real-world settings.
Methods
We analyzed propensity score matched cohorts of patients eligible for Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) from Japan cardiac device treatment registry (JCDTR) and Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). The former served as the defibrillator therapy group and the latter as the conventional therapy group.
Results
During an average follow-up of 24 months, death occurred in 35 of 285 patients (12%) with defibrillator therapy and 65 of 285 patients (23%) with conventional therapy. Adjusted hazard ratios of all-cause death, sudden death, heart failure death, and noncardiac death in defibrillator versus conventional therapy were 0.616 (95% confidence interval [CI]: 0.402–0.943, p = 0.026), 0.274 (95% CI: 0.103–0.731, p = 0.0097), 0.362 (95% CI: 0.172–0.764, p = 0.0077) and 1.45 (95% CI: 0.711–2.949, p = 0.31). After accounting for death without appropriate defibrillator therapy as a competing risk, the cumulative incidence of first appropriate defibrillator therapy in the defibrillator therapy group was nearly identical to that of all-cause death in the conventional therapy group. Subgroup analyses indicated a lack of defibrillator benefit in patients with hypertension (p = 0.01 for interaction).
Conclusions
Primary prevention ICD/CRT-D reduced the risk of all-cause mortality of patients with HFrEF eligible for SCD-HeFT compared to conventional therapy in the real-world cohort.
CONFLICT OF INTEREST STATEMENT
All authors declare no conflict of interest related to this study.
Supporting Information
| Filename | Description |
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| joa370084-sup-0001-supinfo.docxWord 2007 document , 99.1 KB |
Figure S1. CONSORT (Consolidated Standards for Reporting Trials) diagram. Figure S2. Cumulative survival free from all-cause death in heart failure patients with or without a defibrillator. Figure S3. Annual trends in number of patients with primary prevention ICD/CRT-D implantation with the proportion of CRT-D registered in the JCDTR and New JCDTR. Table S1. Complication rates at the implantation and during the follow-up in heart failure patients of the defibrillator therapy group. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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