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Meta-Analysis
. 2022 Jul 29;21(1):143.
doi: 10.1186/s12933-022-01580-y.

Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients

Hualong Liu #  1 , Jinzhu Hu #  1 , Wen Zhuo #  1 , Rong Wan  2 , Kui Hong  3   4
Affiliations
Meta-Analysis

Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients

Hualong Liu et al. Cardiovasc Diabetol. .

Abstract

Background: The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy.

Methods: We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs.

Results: Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36-1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56-2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35-2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39-0.79).

Conclusion: Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited.

Keywords: Diabetes; ICD recipients; ICD therapies; Influence; Mortality.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection process
Fig. 2
Fig. 2
The influence of diabetes on all-cause mortality (A) and cardiac mortality (B) in ICD recipients compared with non-diabetes. ICD implantable cardioverter-defibrillator
Fig. 3
Fig. 3
Subgroup analysis of the increased all-cause mortality caused by diabetes in ICD recipients, stratified according to primary prevention, secondary prevention and primary or secondary prevention
Fig. 4
Fig. 4
The influence of diabetes on appropriate therapy (A), inappropriate therapy (B), appropriate shock (C), inappropriate shock (D), appropriate ATP (E) and inappropriate ATP (F) in ICD recipients compared with non-diabetes. ICD implantable cardioverter-defibrillator ATP anti-tachycardia pacing
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