When compared to patients with non-advanced heart failure, patients with advanced heart failure had a more than three-fold higher risk of dying within a year after receiving a defibrillator.
A recent DCRI-led study on patients who received an implantable cardioverter defibrillator (ICD) or a cardiac resynchronization therapy with a defibrillator (CRT-D) examined the risks that patients with advanced heart failure face when they undergo one of these procedures.
One of the main findings delineated in the paper, which was published recently in JAMA Cardiology, was that patients with advanced heart failure had a 22 percent chance of dying one year after the procedure—more than three-fold higher than their counterparts with non-advanced heart failure.
The study, which was led by former DCRI fellow Marat Fudim, MD (pictured left), compared a group of 3,343 people with advanced heart failure with a group of 19,424 patients with non-advanced heart failure. Both groups were drawn from a cohort of over 80,000 Medicare patients enrolled in the National Cardiovascular Data Registry ICD Registry, and each person included in the study underwent first-time ICD or CRT-D placement for primary prevention of sudden cardiac death.
Patients with advanced heart failure were also more likely to die within 30 days (3.1 percent versus less than 0.5 percent in the comparator group), and were more likely to experience periprocedural complications (3.74 percent versus less than 1.1 percent in the comparator group). Most of the complications were in-hospital fatalities or resuscitated cardiac arrests.
The study also examined risk factors for death within the advanced heart failure cohort. Patients had a higher risk of death if they had ischemic heart disease, diabetes, or New York Heart Association class IV symptoms.
“Clinicians should be aware of these differences in outcomes for patients with advanced heart failure, and these findings should be a part of shared decision making tools and encounters,” said the DCRI’s Sana Al-Khatib, MD, MHS (pictured right), corresponding author for this paper and the chair of the 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
“Because the pivotal trials that proved the value of ICDs did not include patients with advanced heart failure, we are lacking data on how these patients fare after they receive a device,” Fudim said. “By examining patient outcomes in the real world, we were able to make some important observations that can aid in clinicians’ treatment decisions when caring for these high-risk patients.”
Other DCRI contributors to this study include Sean Pokorney, MD, MBA, and Adrian Hernandez, MD, MHS.