title: Influence of diabetes mellitus on inappropriate and appropriate implantable cardioverter-defibrillator therapy and mortality in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) Trial.
abstract: BACKGROUND
  The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy delivery in these patients is unknown.
  
  
  RESULTS
  The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) randomized patients with a primary prophylactic ICD indication to 3 different types of ICD programming: conventional programming with a ventricular tachycardia zone of 170 to 199 bpm (arm A), high-rate cutoff with a ventricular tachycardia zone ≥200 bpm (arm B), or 60-second-delayed therapy (arm C). The end points of inappropriate therapy, appropriate therapy, and death were assessed among 485 patients with and 998 without diabetes mellitus. Innovative ICD programming reduced the risk of inappropriate therapy regardless of diabetes mellitus, although a trend toward a more pronounced effect of high-rate cutoff programming was seen in patients without diabetes mellitus (P for interaction=0.06). Diabetes mellitus was associated with a decreased risk of inappropriate therapy (hazard ratio, 0.54; 95% confidence interval, 0.36-0.80; P=0.002) and increased risk of appropriate therapy (hazard ratio, 1.58; 95% confidence interval, 1.17-2.14; P=0.003). In diabetic patients, there was significantly increased risk of death in those who had inappropriate therapy (hazard ratio, 4.17; 95% confidence interval, 1.52-11.40; P=0.005) and appropriate therapy (hazard ratio, 2.49; 95% confidence interval, 1.06-5.87; P=0.037) compared with those who did not.
  
  
  CONCLUSIONS
  Innovative high-rate cutoff or delayed ICD programming was associated with a reduction in inappropriate therapy in patients with and without diabetes mellitus. Diabetes mellitus was associated with lower risk of inappropriate therapy but higher risk of appropriate therapy. Appropriate and inappropriate ICD therapy was associated with increased mortality in diabetic patients.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER: NCT00947310.
authors.affiliation: Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY 14642, USA. mruwald@hotmail.com
authors.forename: Martin H
authors.initials: MH
authors.lastname: Ruwald
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Christian
authors.initials: C
authors.lastname: Jons
authors.forename: Claire
authors.initials: C
authors.lastname: Zhang
authors.forename: Anne-Christine H
authors.initials: AC
authors.lastname: Ruwald
authors.forename: Brian
authors.initials: B
authors.lastname: Olshansky
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.forename: Poul Erik
authors.initials: PE
authors.lastname: Bloch Thomsen
authors.forename: Morio
authors.initials: M
authors.lastname: Shoda
authors.forename: Bela
authors.initials: B
authors.lastname: Merkely
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
mesh_terms: D000368:Aged; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D048909:Diabetes Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D016016:Proportional Hazards Models; D012306:Risk; D016037:Single-Blind Method; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D019564:Unnecessary Procedures
keywords: defibrillators, implantable; diabetes mellitus; heart failure; mortality