PMID- 28888266
OWN - NLM
STAT- MEDLINE
DCOM- 20170919
LR  - 20181113
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 191
DP  - 2017 Sep
TI  - New York Heart Association class and the survival benefit from primary prevention 
      implantable cardioverter defibrillators: A pooled analysis of 4 randomized 
      controlled trials.
PG  - 21-29
LID - S0002-8703(17)30174-6 [pii]
LID - 10.1016/j.ahj.2017.06.002 [doi]
AB  - BACKGROUND: Primary prevention implantable cardioverter defibrillator (ICD) 
      reduce all-cause mortality by reducing sudden cardiac death. There are 
      conflicting data regarding whether patients with more advanced heart failure 
      derive ICD benefit owing to the competing risk of nonsudden death. METHODS: We 
      performed a patient-level meta-analysis of New York Heart Association (NYHA) 
      class II/III heart failure patients (left ventricular ejection fraction </=35%) 
      from 4 primary prevention ICD trials (MADIT-I, MADIT-II, DEFINITE, SCD-HeFT). 
      Bayesian-Weibull survival regression models were used to assess the impact of 
      NYHA class on the relationship between ICD use and mortality. RESULTS: Of the 
      2,763 patients who met study criteria, 68% (n=1,867) were NYHA II and 52% 
      (n=1,435) were randomized to an ICD. In a multivariable model including all study 
      patients, the ICD reduced mortality (hazard ratio [HR] 0.65, 95% posterior 
      credibility interval [PCI]) 0.40-0.99). The interaction between NYHA class and 
      the ICD on mortality was significant (posterior probability of no 
      interaction=.036). In models including an interaction term for the NYHA class and 
      ICD, the ICD reduced mortality among NYHA class II patients (HR 0.55, PCI 
      0.35-0.85), and the point estimate suggested reduced mortality in NYHA class III 
      patients (HR 0.76, PCI 0.48-1.24), although this was not statistically 
      significant. CONCLUSIONS: Primary prevention ICDs reduce mortality in NYHA class 
      II patients and trend toward reducing mortality in the heterogeneous group of 
      NYHA class III patients. Improved risk stratification tools are required to guide 
      patient selection and shared decision making among NYHA class III primary 
      prevention ICD candidates.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Friedman, Daniel J
AU  - Friedman DJ
AD  - Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, 
      NC.
FAU - Al-Khatib, Sana M
AU  - Al-Khatib SM
AD  - Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, 
      NC.
FAU - Zeitler, Emily P
AU  - Zeitler EP
AD  - Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, 
      NC.
FAU - Han, JooYoon
AU  - Han J
AD  - University of Washington, Seattle, WA.
FAU - Bardy, Gust H
AU  - Bardy GH
AD  - University of Washington, Seattle, WA.
FAU - Poole, Jeanne E
AU  - Poole JE
AD  - University of Washington, Seattle, WA.
FAU - Bigger, J Thomas
AU  - Bigger JT
AD  - Columbia University, New York, NY.
FAU - Buxton, Alfred E
AU  - Buxton AE
AD  - Beth Israel Deaconess Medical Center, Boston, MA.
FAU - Moss, Arthur J
AU  - Moss AJ
AD  - University of Rochester, Rochester, NY.
FAU - Lee, Kerry L
AU  - Lee KL
AD  - Duke Clinical Research Institute, Durham, NC.
FAU - Steinman, Richard
AU  - Steinman R
AD  - Columbia University, New York, NY.
FAU - Dorian, Paul
AU  - Dorian P
AD  - University of Toronto, Toronto, Ontario, Canada.
FAU - Cappato, Riccardo
AU  - Cappato R
AD  - Humanitas University and Humanitas Clinical Research Center, Milan, Italy.
FAU - Kadish, Alan H
AU  - Kadish AH
AD  - Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL.
FAU - Kudenchuk, Peter J
AU  - Kudenchuk PJ
AD  - University of Washington, Seattle, WA.
FAU - Mark, Daniel B
AU  - Mark DB
AD  - Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, 
      NC.
FAU - Inoue, Lurdes Y T
AU  - Inoue LYT
AD  - University of Washington, Seattle, WA.
FAU - Sanders, Gillian D
AU  - Sanders GD
AD  - Duke Clinical Research Institute, Durham, NC. Electronic address: 
      gillian.sanders@duke.edu.
LA  - eng
GR  - R01 HL131754/HL/NHLBI NIH HHS/United States
GR  - R01 HS018505/HS/AHRQ HHS/United States
GR  - T32 HL069749/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20170609
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - *Cardiology
MH  - *Death, Sudden, Cardiac/epidemiology/etiology/prevention & control
MH  - *Defibrillators, Implantable
MH  - Global Health
MH  - Heart Failure/complications/mortality/*therapy
MH  - Humans
MH  - New York
MH  - Primary Prevention/*methods
MH  - *Randomized Controlled Trials as Topic
MH  - *Societies, Medical
MH  - Survival Rate/trends
PMC - PMC5657554
MID - NIHMS883612
EDAT- 2017/09/11 06:00
MHDA- 2017/09/20 06:00
PMCR- 2018/09/01
CRDT- 2017/09/11 06:00
PHST- 2017/02/02 00:00 [received]
PHST- 2017/06/06 00:00 [accepted]
PHST- 2017/09/11 06:00 [entrez]
PHST- 2017/09/11 06:00 [pubmed]
PHST- 2017/09/20 06:00 [medline]
PHST- 2018/09/01 00:00 [pmc-release]
AID - S0002-8703(17)30174-6 [pii]
AID - 10.1016/j.ahj.2017.06.002 [doi]
PST - ppublish
SO  - Am Heart J. 2017 Sep;191:21-29. doi: 10.1016/j.ahj.2017.06.002. Epub 2017 Jun 9.