Incidence of appropriate cardioverter-defibrillator shocks and mortality in patients with heart failure treated with combined cardiac resynchronization plus implantable cardioverter-defibrillator therapy versus implantable cardioverter-defibrillator therapy.
Of 529 patients with heart failure and a mean left ventricular ejection fraction of 29%, 209 (40%) were treated with cardiac resynchronization therapy (CRT) plus an implantable cardioverter-defibrillator (ICD) and 320 (60%) with an ICD. Mean follow-up was 34 months for both groups. Stepwise logistic regression analysis showed that significant independent variables for appropriate ICD shocks were statins (risk ratio = 0.35, P < .0001), smoking (risk ratio = 2.52, P < .0001), and digoxin (risk ratio = 1.92, P = .0001). Significant independent variables for time to deaths were use of CRT (risk ratio = 0.32, P = .0006), statins (risk ratio = 0.18, P < .0001), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (risk ratio = 0.10, P < .0001), hypertension (risk ratio = 24.15, P < .0001), diabetes (risk ratio = 2.54, P = .0005), and age (risk ratio = 1.06, P < .0001). In conclusion, statins reduced and smoking and digoxin increased appropriate ICD shocks. Use of CRT, statins, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers reduced mortality and hypertension, diabetes, and older age increased mortality.
Desai
Harit
H
Department of Medicine, Cardiology Division, New York Medical College, Valhalla, NY 10595, USA.
Aronow
Wilbert S
WS
Ahn
Chul
C
Tsai
Fausan S
FS
Lai
Hoang M
HM
Gandhi
Kaushang
K
Amin
Harshad
H
Frishman
William H
WH
Kalapatapu
Kumar
K
Cohen
Martin
M
Sorbera
Carmine
C
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D000806:Angiotensin-Converting Enzyme Inhibitors