title: Implantable cardioverter-defibrillators in patients hospitalized for heart failure with chronically reduced left ventricular ejection fraction.
abstract: The aim of this study was to investigate the association between implantable cardioverter-defibrillator (ICD) status at the time of hospitalization for worsening heart failure (HF) with postdischarge events in patients with reduced left ventricular ejection fraction. We conducted an analysis of 4133 patients hospitalized for HF with left ventricular ejection fraction 40% or less in EVEREST. The final analysis included patients without an electrophysiological device (n = 3102) and those with an ICD (n = 600) at the time of enrollment. During a median follow-up of 300 days, all-cause mortality was 22.9% in the no device group and 35.2% in the ICD group (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.39-1.89). Rehospitalization for HF was 27.0% in the no device group and 46.8% in the ICD group (HR, 2.20; 95% CI, 1.92-2.52). After adjustment for multiple variables, the rates for all-cause mortality were similar (HR, 1.01; 95% CI, 0.83-1.22), but the ICD group had elevated rates of HF hospitalizations compared with the no device group (HR, 1.35; 95% CI, 1.14-1.60). In patients with reduced left ventricular ejection fraction, an ICD at presentation for hospitalization for worsening HF was associated with similar rates of death but higher rates of rehospitalization for HF. Given our findings, further studies should investigate optimization of care in patients already implanted with an ICD as well as the role of ICD implantation during or soon after hospitalization for HF in patients not yet implanted.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Norman C
authors.initials: NC
authors.lastname: Wang
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Brian
authors.initials: B
authors.lastname: Traver
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: James E
authors.initials: JE
authors.lastname: Udelson
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Thomas
authors.initials: T
authors.lastname: Cook
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Alan B
authors.initials: AB
authors.lastname: Miller
authors.forename: Liliana
authors.initials: L
authors.lastname: Grinfeld
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*