title: Outcomes in African Americans undergoing cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: findings from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD).
abstract: BACKGROUND
  Implantable cardioverter-defibrillators (ICDs) reduce the risk of death in patients with left ventricular dysfunction. Little is known regarding the benefit of this therapy in African Americans (AAs).
  
  
  OBJECTIVE
  The purpose of this study was to determine the association between AA race and outcomes in a cohort of primary prevention ICD patients.
  
  
  METHODS
  We conducted a prospective cohort study of patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end-point was appropriate ICD shock defined as a shock for rapid ventricular tachyarrhythmias. The secondary end-point was all-cause mortality.
  
  
  RESULTS
  There were 1189 patients (447 AAs and 712 non-AAs) enrolled. Over a median follow-up of 5.1 years, a total of 137 patients experienced an appropriate ICD shock, and 343 died (294 of whom died without receiving an appropriate ICD shock). The multivariate adjusted hazard ratio (95% confidence interval) comparing AAs vs non-AAs were 1.24 (0.96-1.59) for all-cause mortality, 1.33 (1.02, 1.74) for all-cause mortality without receiving appropriate ICD shock, and 0.78 (0.51, 1.19) for appropriate ICD shock. Ejection fraction, diabetes, and hypertension appeared to explain 24.1% (10.1%-69.5%), 18.7% (5.3%-58.0%), and 13.6% (3.8%-53.6%) of the excess risk of mortality in AAs, with a large proportion of the mortality difference remaining unexplained.
  
  
  CONCLUSIONS
  In patients with primary prevention ICDs, AAs had an increased risk of dying without receiving an appropriate ICD shock compared to non-AAs.
authors.affiliation: Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Munson Medical Center, Traverse City, Michigan.
authors.forename: Robert
authors.initials: R
authors.lastname: Kennedy
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Elena
authors.initials: E
authors.lastname: Blasco-Colmenares
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Butcher
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Norgard
authors.affiliation: Washington Hospital Center, Washington, DC.
authors.forename: Zayd
authors.initials: Z
authors.lastname: Eldadah
authors.affiliation: University of Maryland, Baltimore, Maryland.
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
authors.affiliation: Medical College of Virginia, Richmond, Virginia.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Tomaselli
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: alcheng@jhmi.edu.
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
mesh_terms: D001741:Black or African American; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*
keywords: African American; All-cause mortality; Implantable cardioverter-defibrillator; Sudden cardiac death; implantable cardioverter-defibrillator shock