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

Rørth, Rasmus, Dewan, Pooja ORCID: https://orcid.org/0000-0003-2927-4075, Kristensen, Søren Lund, Jhund, Pardeep S. ORCID: https://orcid.org/0000-0003-4306-5317, Petrie, Mark C. ORCID: https://orcid.org/0000-0002-6333-9496, Køber, Lars and McMurray, John J.V. ORCID: https://orcid.org/0000-0002-6317-3975(2019) Efficacy of an implantable cardioverter-defibrillator in patients with diabetes and heart failure and reduced ejection fraction.Clinical Research in Cardiology, 108(8), pp. 868-877. (doi: 10.1007/s00392-019-01415-z) (PMID:30689020) (PMCID:PMC6652172)

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.

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