Implantable cardioverter-defibrillators confer survival benefit in patients with chronic obstructive pulmonary disease

Abstract

Background: The prophylactic use of the implantable cardioverter-defibrillator (ICD) has been shown to decrease mortality in patients with depressed left ventricular ejection function (LVEF ≤ 35%). Whether this beneficial effect persists in the presence of chronic obstructive pulmonary disease (COPD) is not established.

Methods: We examined the medical records of patients with LVEF ≤ 35% and COPD and analyzed the data for total mortality by ICD status. Each ICD patient was matched by age and LVEF with two to three controls. The Charlson comorbidity index and propensity score were used to correct for differences in comorbidities and biases between the study groups.

Results: A total of 100 patients (30 with ICD and 70 controls) were included in this analysis. The overall cohort had a mean age of 65 ± 15 years with a predominance of white (79%) men (72%). Compared to controls, ICD patients had a wider QRS complex (150 ± 32 ms vs 110 ± 24 ms, P < 0.001) and were less likely to be on steroid therapy (10% vs 31%, P = 0.018) for COPD. At a mean follow-up of 3.1 ± 2.7 years, ICD patient had a lower total mortality (2-year survival of 88% in the ICD group vs 59% in the controls, P = 0.016). The lower death rate in the ICD group persisted after correcting for differences in the QRS interval and for discrepancies race and in the incidence of steroid use in a multivariate Cox regression model (odds ratio = 0.300, adjusted P = 0.016).

Conclusion: Patients with COPD extract survival benefit from the ICD and should therefore not be denied this life-saving therapy.