Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study
Abstract Background In the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor...
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BMC
2024-11-01
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| Online Access: | https://doi.org/10.1186/s12916-024-03761-w |
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| author | Anil Sahin Ahmet Celik Dilek Ural Inci Tugce Colluoglu Naim Ata Emine Arzu Kanik Mustafa Mahir Ulgu Suayip Birinci Mehmet Birhan Yilmaz |
| author_facet | Anil Sahin Ahmet Celik Dilek Ural Inci Tugce Colluoglu Naim Ata Emine Arzu Kanik Mustafa Mahir Ulgu Suayip Birinci Mehmet Birhan Yilmaz |
| author_sort | Anil Sahin |
| collection | DOAJ |
| description | Abstract Background In the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients. Methods Utilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality. Results In the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4%) in the GDMT group and 101 out of 619 patients (16.3%) in the ICD group, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) ranging from 0.57 to 0.98. The median follow-up time was 1365 days in the matched cohort, 1283 days in the GDMT group. Subgroup analyses consistently demonstrated benefits, particularly among individuals aged 61 years and older (HR: 0.60, 95% CI: 0.42–0.87, p = 0.006), those with sinus rhythm (HR: 0.55, 95% CI: 0.34–0.89, p = 0.013), individuals not using amiodarone (HR: 0.61, 95% CI: 0.42–0.89, p = 0.011), and those with an estimated glomerular filtration rate lower than 61.9 (HR: 0.66, 95% CI: 0.48–0.91, p = 0.011). Conclusions This study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF. Graphical Abstract |
| format | Article |
| id | doaj-art-e47b7c868a3540fd8dd65fc2b4d37fc9 |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj-art-e47b7c868a3540fd8dd65fc2b4d37fc92024-11-24T12:29:28ZengBMCBMC Medicine1741-70152024-11-0122111010.1186/s12916-024-03761-wImpact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched studyAnil Sahin0Ahmet Celik1Dilek Ural2Inci Tugce Colluoglu3Naim Ata4Emine Arzu Kanik5Mustafa Mahir Ulgu6Suayip Birinci7Mehmet Birhan Yilmaz8Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet UniversityDepartment of Cardiology, Faculty of Medicine, Mersin UniversityDepartment of Cardiology, Faculty of Medicine, Koç UniversityDepartment of Cardiology, Faculty of Medicine, Karabük UniversityGeneral Directorate of Information Systems, Ministry of HealthDepartment of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin UniversityGeneral Directorate of Information Systems, Ministry of HealthDeputy Minister of Health, Ministry of HealthDepartment of Cardiology, Faculty of Medicine, Dokuz Eylül UniversityAbstract Background In the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients. Methods Utilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality. Results In the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4%) in the GDMT group and 101 out of 619 patients (16.3%) in the ICD group, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) ranging from 0.57 to 0.98. The median follow-up time was 1365 days in the matched cohort, 1283 days in the GDMT group. Subgroup analyses consistently demonstrated benefits, particularly among individuals aged 61 years and older (HR: 0.60, 95% CI: 0.42–0.87, p = 0.006), those with sinus rhythm (HR: 0.55, 95% CI: 0.34–0.89, p = 0.013), individuals not using amiodarone (HR: 0.61, 95% CI: 0.42–0.89, p = 0.011), and those with an estimated glomerular filtration rate lower than 61.9 (HR: 0.66, 95% CI: 0.48–0.91, p = 0.011). Conclusions This study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF. Graphical Abstracthttps://doi.org/10.1186/s12916-024-03761-wQuadruple guideline-directed medical therapyImplantable cardioverter-defibrillatorMortality |
| spellingShingle | Anil Sahin Ahmet Celik Dilek Ural Inci Tugce Colluoglu Naim Ata Emine Arzu Kanik Mustafa Mahir Ulgu Suayip Birinci Mehmet Birhan Yilmaz Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study BMC Medicine Quadruple guideline-directed medical therapy Implantable cardioverter-defibrillator Mortality |
| title | Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study |
| title_full | Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study |
| title_fullStr | Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study |
| title_full_unstemmed | Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study |
| title_short | Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study |
| title_sort | impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline directed medical therapy a propensity score matched study |
| topic | Quadruple guideline-directed medical therapy Implantable cardioverter-defibrillator Mortality |
| url | https://doi.org/10.1186/s12916-024-03761-w |
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