ICD Therapy for Cardiomyopathy More Effective Than Conventional Care

Implantable cardioverter-defibrillators (ICDs) could potentially reduce the risk of sudden and all-cause death in patients at risk for life-threatening ventricular arrhythmias, according to a recent study.

The researchers analyzed data from 11 randomized controlled trials published from April 1, 1976 through March 31, 2017 that compared ICD therapy with conventional care among 8716 patients. Of the trials, 4 included 1781 patients with nonischemic cardiomyopathy, 6 included 4414 patients with ischemic cardiomyopathy, and 1 included 2521 patients with either nonischemic or ischemic cardiomyopathy.
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Over the mean 3.2 years of follow-up, ICD therapy was associated with a greater overall reduction in all-cause mortality compared with conventional care (21.37% vs 28.26%, respectively). The magnitude of reduction was similar among cohorts with nonischemic and ischemic cardiomyopathy, although the estimate for ischemic cardiomyopathy did not reach statistical significance.

The rate of sudden death for patients who received ICD therapy fell from 12.15% associated with conventional care to 4.39%, and the magnitude of reduction was similar for patients with ischemic and nonischemic cardiomyopathy.

“Overall, primary prevention with ICD therapy versus conventional care reduced the incidence of sudden and all-cause death,” the researchers concluded.

—Melissa Weiss

Reference:

Kołodziejczak M, Andreotti F, Kowalewski M, et al. Implantable cardioverter-defibrillators for primary prevention in patients with ischemic or nonischemic cardiomyopathy: a systematic review and meta-analysis [published online June 27, 2017]. Ann Intern Med. doi:10.7326/M17-0120.