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Randomized Controlled Trial
. 2019 Apr;6(2):297-307.
doi: 10.1002/ehf2.12407. Epub 2019 Feb 27.

Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial

Tetz C Lee  1 , Min Qian  1 , Lan Mu  1 , Marco R Di Tullio  1 , Susan Graham  2 , Douglas L Mann  3 , Koki Nakanishi  1 , John R Teerlink  4 , Gregory Y H Lip  5 , Ronald S Freudenberger  6 , Ralph L Sacco  7 , Jay P Mohr  1 , Arthur J Labovitz  8 , Piotr Ponikowski  9 , Dirk J Lok  10 , Conrado Estol  11 , Stefan D Anker  12   13 , Patrick M Pullicino  14 , Richard Buchsbaum  1 , Bruce Levin  1 , John L P Thompson  1 , Shunichi Homma  1 , Siqin Ye  1 ; WARCEF Investigators
Affiliations
Randomized Controlled Trial

Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial

Tetz C Lee et al. ESC Heart Fail. 2019 Apr.

Abstract

Aims: There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial.

Methods and results: We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131).

Conclusions: The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.

Keywords: Heart failure with reduced ejection fraction; Implantable cardioverter-defibrillator; Non-ischaemic cardiomyopathy; Propensity score matching.

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Conflict of interest statement

S.D.A. reports being a consultant for Bayer, Boehringer Ingelheim, Novartis, Stealth Peptides, Servier, Vifor, and Janssen (all for trial/registry steering committee work), and he has received research grants from Abbott Vascular and Vifor. S.H. reports being a consultant for St. Jude Medical, Daiichi Sankyo, Bristol‐Myers Squibb, and Pfizer. A.J.L. has received a research grant from Bristol‐Myers Squibb/Pfizer for the AREST trial. G.Y.H.L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi Sankyo and speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi Sankyo. No fees are directly received personally. R.L.S. has received research grants from NINDS, NCATS, AHA, Evelyn McKnight Brain Foundation, and Boehringer Ingelheim. J.R.T. has received consulting fees/research grants from Actelion, Amgen, Bayer, Cytokinetics, Medtronic, Novartis, St. Jude Medical, and Trevena. The other authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
Overview of the study cohort. ICD, implantable cardioverter‐defibrillator.
Figure 2
Figure 2
Kaplan–Meier curves showing the survival of those with and without an implantable cardioverter‐defibrillator: (A) patients with non‐ischaemic heart failure and (B) patients with ischaemic heart failure.
See this image and copyright information in PMC

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