PMID- 20357388
OWN - NLM
STAT- MEDLINE
DCOM- 20100604
LR  - 20211028
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 96
IP  - 8
DP  - 2010 Apr
TI  - Is there benefit in implanting defibrillators in patients with severe heart 
      failure?
PG  - 599-603
LID - 10.1136/hrt.2009.179515 [doi]
AB  - BACKGROUND: It is current practice to withhold implantable cardioverter 
      defibrillators (ICD) from patients with severe heart failure because their deaths 
      are judged as non-sudden and therefore assumed not to be preventable by ICD. If 
      this was true, there should be a trend towards reduced preventability of deaths 
      in the severe heart failure subgroups within existing randomised control ICD 
      trials. We tested the prevailing assumption that patients with most severe heart 
      failure would not benefit from ICD implantation. METHODS Six trials were 
      identified enrolling 7873 patients, with 2734 patients randomly assigned to 
      receive an ICD. Reduction in mortality in the ICD arm varied between 5.6% and 
      31%. All six trials provided data separated into higher and lower ejection 
      fraction subgroups. Five trials provided data separated into higher and lower New 
      York Heart Association (NYHA) class patient subgroups. RESULTS: For patients 
      subcategorised by NYHA class, there was a non-significant difference in z-score 
      (p=0.922) between patients with mild to moderate and severe heart failure. 
      Similarly, subgrouping by left ventricular ejection fraction (LVEF) revealed no 
      significant difference between z-scores (p=0.170). Both observations suggest no 
      attenuation of benefit of ICD implantation in patients with higher NYHA class or 
      lower LVEF. CONCLUSION: There is no evidence within the existing trial 
      populations of a tendency for the relative risk reduction to be smaller in 
      patients with severe heart failure. The prevailing assumption that severe heart 
      failure patients are less likely to benefit from ICD therapy must be questioned.
FAU - Salukhe, Tushar V
AU  - Salukhe TV
AD  - International Centre for Circulatory Health, National Heart and Lung Institute, 
      Imperial College London, 59-61 North Wharf Road, London, UK. salukhe@aol.com
FAU - Briceno, Natalia I
AU  - Briceno NI
FAU - Ferenczi, Emily A
AU  - Ferenczi EA
FAU - Sutton, Richard
AU  - Sutton R
FAU - Francis, Darrel P
AU  - Francis DP
LA  - eng
GR  - FS/10/38/28268/BHF_/British Heart Foundation/United Kingdom
GR  - FS/09/018/26963/BHF_/British Heart Foundation/United Kingdom
PT  - Evaluation Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
MH  - *Defibrillators, Implantable
MH  - Heart Failure/mortality/*therapy
MH  - Humans
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/mortality/therapy
RF  - 19
EDAT- 2010/04/02 06:00
MHDA- 2010/06/05 06:00
CRDT- 2010/04/02 06:00
PHST- 2010/04/02 06:00 [entrez]
PHST- 2010/04/02 06:00 [pubmed]
PHST- 2010/06/05 06:00 [medline]
AID - 96/8/599 [pii]
AID - 10.1136/hrt.2009.179515 [doi]
PST - ppublish
SO  - Heart. 2010 Apr;96(8):599-603. doi: 10.1136/hrt.2009.179515.