PO-05-058 PROGNOSTIC EVALUATION OF PATIENTS WITH ICD IN A LATIN AMERICAN TERTIARY CENTER.

Abstract

Despite advances in ICD, SCD remains a public health problem. Chagas disease, still prevalent in Brazil, is associated with higher VT and VF events and SCD when compared to other cardiopathies. Data are conflicting in correlating mortality reduction in chagasic patients and the ICD implantation. We aimed to evaluate the ICD receivers mortality after structuring arrhythmia service in a Latin American tertiary center. Evaluate if the mortality and VT/VF events decrease when patients who received ICD at different periods of time (2007-2010, 2011-2014, 2015-2018) are compared in a tertiary center; compare the prognosis of chagasic to non-chagasic patients in different periods. Retrospective observational study of patients with ICD implanted in the Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) between October 2007 and December 2018. The primary outcome was mortality, evaluated in the total sample and in each period. The secondary outcomes were the VT/VF events and the combined outcome of death and/or VT/VF, evaluated in the total sample and in each period. A total of 885 patients were included, 31% chagasic. Out of these, 254 (28%) died, 127 (14%) had VT/VF and 329 (37%) died and/or had VT/VF. The Kaplan-Meier curves showed that period 3 vs. 1 was the only variable associated with better death-free survival, p=0.007. For the VT/VF and the combined outcome free survival curves, Chagas disease was the only variable associated with higher rate of events; p<0.001 and p=0.009, respectively. In the cox's analysis adjusted for age, sex and Chagas, period 2 vs. 1 was protective for death (HR 0.715, 95%CI 0.539-0.948) and combined outcome (HR 0.713, 95%CI 0.537-0.945); period 3 vs. 1 was protective for death (HR 0.516, 95%CI 0.351-0.759) and combined outcome (HR 0.530, 95%CI 0.361-0.780). After adjusting for age and gender, Chagas was associated with VT/VF in periods 1 (HR 2.531, 95%CI 1.469-4.360) and 2 (HR 3.247, 95%CI 1.735-6.076). There was a gradual reduction in mortality and combined outcome for ICD receivers at periods 2011-2014 and 2015-2018 compared to the initial period 2007-2010. Chagas was associated with a higher VT/VF events in ICD receivers only in the first two periods. The improvement of results was concomitant with the incorporation of new modalities and technologies to treat patients with ICD. The better organization of care may be associated with reduction of overall mortality and arrhythmic events in this population.