Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
ICD Implantation in Patients with Nonischemic Systolic HF
N Engl J Med; 2016 Sep 29; Køber, Thune, et al
In patients with symptomatic systolic heart failure not caused by coronary artery disease, prophylactic implantable cardioverter-defibrillator (ICD) implantation was not associated with a significantly lower long-term rate of death from any cause, a recent study found. In this randomized, controlled trial, 556 patients with symptomatic systolic heart failure not caused by coronary artery disease were assigned to receive an ICD, and 560 patients were assigned to receive usual care. In both groups, 58% of the patients received cardiac resynchronization therapy (CRT). Researchers found:
- The primary outcome (death from any cause) occurred in 120 (21.6%) patients in the ICD group and in 131 (23.4%) patients in the control group after median follow-up of 67.6 months.
- Sudden cardiac death occurred in 24 (4.3%) patients in the ICD group and in 46 (8.2%) patients in the control group.
- 27 (4.9%) patients in the ICD group and 20 (3.6%) patients in the control group developed device infection.
Køber L, Thune JJ, Nielsen JC, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med. 2016;375:1221-1230. doi:10.1056/NEJMoa1608029.
Current American Heart Association guidelines recommend implantable cardioverter–defibrillator (ICD) for patients with CHF and an ejection fraction < 35%.1 The recommendation is based on data of ICD providing decreased risk of sudden death secondary to arrhythmia and decreased total mortality in patients with ischemic heart disease. This study raises as many questions as it answers. There was a significant decrease of approximately 50% in the occurrence of sudden death in the ICD group, though this did translate to a difference in total mortality. What this meant was that many people died from causes other than those related to their CHF, which may explain why younger people in this trial had a greater benefit from ICD implantation than older people. This led the authors to conclude that, “patients who are not expected to die from other causes may be good candidates for ICD implantation.” —Neil Skolnik, MD
1. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-327.