Patients with improved left ventricular ejection fraction without implantable cardioverter defibrillator may continue to be at high mortality risk despite optimal medical management
Singh KY, Zahwe F, Mengesha T, et al. Patients with improved left ventricular ejection fraction without implantable cardioverter defibrillator may continue to be at high mortality risk despite optimal medical management. Poster presented at: Heart Rhythm Scientific Sessions; May 12, 2017; Chicago, IL.
Poster presented at: Heart Rhythm Scientific Sessions; May 12, 2017; Chicago, IL.
BACKGROUND: With advances in medical and interventional management, the risk of sudden cardiac death (SCD) has decreased in the high-risk patients identified by left ventricular ejection fraction (LVEF) <35%. However, in the cohort of patients who have improved LVEF and no ICD, whether ICD would have benefitted remains largely unknown.
OBJECTIVE: To evaluate benefit of ICD in addition to optimal medical management (OMT) in patients with improved LVEF.
METHODS: Aurora Healthcare patient records from 1/2010 to 10/2014 were screened to identify patients with LVEF≤35% and subsequent improvement to EF≥40%, in whom ICD implant was deferred vs. patients who received ICD. Propensity score matching was applied to match the medications and other clinical confounders. The primary outcome was all-cause mortality.
RESULTS: One thousand three hundred sixty-four patients were identified with improved LVEF during the study period. We further propensity matched both groups for clinical characteristics and medications at improved LVEF (40-49%) to evaluate additional benefit of ICD in this cohort of patients. A total of 540 patients were included in the mortality analysis. Sixty-eight patients (15%) in non-ICD group died (majority as SCD) as compared to 10 (9%) in the ICD group (majority non-SCD), p=0.0108 . This effect was not statistically significant in patients with completely recovered LVEF >50%.
CONCLUSIONS: Our findings suggest that the ICD may continue to provide survival benefit over and above OMT in patients with improved LVEF.