B-AB11-04 ASSOCIATION BETWEEN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR AND SURVIVAL IN PATIENTS AWAITING HEART TRANSPLANTATION: A META-ANALYSIS AND SYSTEMATIC REVIEW

Abstract

Patients with end-stage heart failure (HF) are at high risk of sudden cardiac death. However, implantable cardioverter-defibrillator (ICD) is not routinely recommended given the high competing risk of pump failure. A unique population worth separate consideration are patients with end-stage HF awaiting heart transplantation (HT) as prolonged survival improves the chances of receiving HT given the long wait times. To evaluate the association between presence of ICD and survival in patients with end stage heart failure awaiting HT. We performed an extensive literature search and systematic review of studies that compared HF patients with and without an ICD awaiting heart transplantation. We separately assessed the rates of total mortality, sudden cardiac death (SCD), non-SCD, and HT. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts. Ten studies with a total of 36,205 patients were included. 62% of patients had ICD implanted. Patients with an ICD had decreased total mortality (9.7% vs 17.1%, RR 0.62, 95% CI 0.52 - 0.73, p < 0.0001), SCD (1.0% vs 10.1%, RR 0.27, 95% CI 0.12 - 0.59, p = 0.001), and increased rates of heart transplantation (64.4% vs 58.9%, RR 1.10, 95% CI 1.05 - 1.15, p < 0.0001). There was no difference in prevalence of non-SCD (16.5% vs 16.9%, RR 0.76, 95% CI 0.51 - 1.13, p = 0.17). ICD implantation in HF patients awaiting HT is associated with improved outcomes, characterized by lower total mortality and SCD in addition to higher rates of HT.