Abstract
Aim: Evaluate prevalence of heart failure (HF) medications and their association with ventricular arrhythmia (VA) and survival among patients implanted with primary prevention implantable cardiac defibrillator (ICD)/cardiac resynchronization therapy + defibrillator (CRTD) devices. Methods: Association of treatment and dose (% guideline recommended target) of beta-adrenergic receptor antagonist (BB), angiotensin-antagonists (AngA), and mineralocorticoid-antagonists (MRA), after ICD/CRTD implant with VA and mortality was retrospectively analyzed. Results: Study included 186 HF patients; 42.5% and 57.5% implanted with ICD and CRTD, respectively. During 3.8 (2.1;6.7) years; 52 (28%) had VA and 77 (41.4%) died. Treatment (% of patients) included: BB (83%), AngA (87%), and MRA (59%). Median doses were 25(12.5;50)% of target for all medications. BB treatment >25% target dose was associated with reduced VA incidence. In the multivariable model including age, gender, diabetes, heart rate, and medication doses, increased BB dose was associated with reduced VA (hazard ratio (HR) 0.443 95% CI 0.222–0.885; p = 0.021). In the multivariable model for overall mortality including age, gender, renal disease, VA, and medical treatment, VA was associated with increased mortality (HR 2.672; 95% CI 1.429–4.999; p = 0.002) and AngA treatment was associated with reduced mortality (HR 0.515; 95% CI 0.285–0.929; p = 0.028). Conclusions: In this cohort of real-life HF patients discharged after ICD/CRTD implant, prevalence of guideline-based HF medications was high, albeit with low doses. Higher BB dose was associated with reduced VA, while AngA was associated with improved survival.
Highlights
Adherence to heart failure (HF) recommended medical treatment guidelines was shown to reduce HF symptoms, HF hospitalizations, and all-cause mortality in multiple publications [1,2,3,4,5,6,7,8,9,10]
This finding was reinforced in a recent meta-analysis of randomized trials evaluating the survival benefit of implantable cardiac defibrillator (ICD) in dilated cardiomyopathy (DCM) patients, revealing loss of the survival benefit in trials where >50% of patients were taking a combination of beta-adrenergic receptor antagonist (BB), angiotensin antagonist (AngA) including Angiotensin Converting Enzyme Inhibitors and Angioentsin Receptor Blockers, and mineralocorticoid receptor antagonist (MRA) [14]
Guideline-recommended disease modifying HF medications were grouped according to mechanism of action as beta-adrenergic receptor antagonist (BB), angiotensin antagonists (AngA) including angiotensin receptor blockers (ARB) or angiotensin conversion enzyme inhibitors (ACE-I), and mineralocorticoid receptor antagonist (MRA)
Summary
Adherence to heart failure (HF) recommended medical treatment guidelines was shown to reduce HF symptoms, HF hospitalizations, and all-cause mortality in multiple publications [1,2,3,4,5,6,7,8,9,10]. A meta-analysis of pivotal HF trials has shown a continuous decline of SCD incidence as the trials became more recent This observation was attributed to the increased utilization of HF guideline-based medications in recent trials compared with older ones [15]. Suggesting that current guideline-based medical therapy may obviate the need of an ICD in selected patients This finding was reinforced in a recent meta-analysis of randomized trials evaluating the survival benefit of ICD in DCM patients, revealing loss of the survival benefit in trials where >50% of patients were taking a combination of beta-adrenergic receptor antagonist (BB), angiotensin antagonist (AngA) including Angiotensin Converting Enzyme Inhibitors and Angioentsin Receptor Blockers, and mineralocorticoid receptor antagonist (MRA) [14]. In contrast with the above-mentioned HF trials, large registries of HF patients have shown relatively low percent of patients treated with optimal HF medical therapy [17,18,19,20]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
