title: Predictors for short-term progressive heart failure death in New York Heart Association II patients implanted with a cardioverter defibrillator--the EVADEF study.
abstract: BACKGROUND
  Sudden cardiac death (SCD) is the predominant cause of mortality in patients with mild heart failure (HF). This 2-year follow-up, multicenter, cohort study aimed to assess the extent to which implantable cardioverter defibrillators (ICDs), by reducing SCD, lead to predominant progressive HF death in mildly symptomatic HF patients at baseline in daily medical practice.
  
  
  METHODS
  Between June 2001 and June 2003, 1,030 New York Heart Association II patients received an ICD in 22 French centers. Sudden cardiac death and progressive HF mortality rates were assessed using competing risk methodology, and predictors for progressive HF at baseline were tested in a multivariate regression model.
  
  
  RESULTS
  During a mean follow-up of 22 +/- 6 months, 114 deaths occurred: 12 (10.5%) due to SCD and 52 (45.6%) due to progressive HF (24-month cause-specific mortality rates of 1.2% [95% CI 0.6-1.9] and 5.4% [95% CI 4.0-6.8], respectively). Diuretics use (hazard ratio [HR] 2.8, 95% CI 1.5-5.5, P = .002), history of atrial fibrillation (HR 2.09, 95% CI 1.2-3.65, P = .01), and low ejection fraction (HR 2.7, 95% CI 1.4-4.8, P = .0008) were independent predictors for progressive HF death, whereas beta-blocker therapy was a protector (HR 0.6, 95% CI 0.3-0.9, P = .04). Half of the patients (48%) who died from progressive HF within 2 years of ICD implant initially presented with enlarged QRS (> or =120 milliseconds).
  
  
  CONCLUSIONS
  Because of ICD efficiency, progressive HF is the main cause of death within 2 years of implant, although these patients are only mildly symptomatic at implantation. In addition to optimal pharmacologic therapy, these results raise the question of systematically implanting ICDs with cardiac resynchronization therapy in patients with electrical asynchronism at baseline.
authors.affiliation: Université Paris-Descartes, Hôpital Européen Georges Pompidou, Département de Cardiologie, Paris, France.eloi_marijon@yahoo.fr
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Akli
authors.initials: A
authors.lastname: Otmani
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.forename: Philippe
authors.initials: P
authors.lastname: Chevalier
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lellouche
authors.forename: Jacques
authors.initials: J
authors.lastname: Mansourati
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.forename: Frédéric
authors.initials: F
authors.lastname: Anselme
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Davy
authors.forename: Fabrice
authors.initials: F
authors.lastname: Extramiana
authors.forename: Françoise
authors.initials: F
authors.lastname: Hidden-Lucet
authors.forename: Vincent
authors.initials: V
authors.lastname: Probst
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.forename: Hassan
authors.initials: H
authors.lastname: Mansour
authors.forename: Michel
authors.initials: M
authors.lastname: Chauvin
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.forename: Thomas
authors.initials: T
authors.lastname: Lavergne
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index