title: Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings.
abstract: BACKGROUND
  The efficacy of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System (SUS).
  
  
  METHODS
  All patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto's test. Prognostic factors were selected using Cox's models.
  
  
  RESULTS
  There were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas' heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation (5.3%) than those undergoing transvenous implantation (1.6%) (p = 0.02).
  
  
  CONCLUSIONS
  The results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.
authors.affiliation: Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil. arnmigowski@yahoo.com.br.
authors.forename: Arn
authors.initials: A
authors.lastname: Migowski
authors.affiliation: University Hospital and School of Medicine, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil. tom1963br@yahoo.com.br.
authors.forename: Antonio Luiz
authors.initials: AL
authors.lastname: Ribeiro
authors.affiliation: Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. carvalho@fiocruz.br.
authors.forename: Marilia Sá
authors.initials: MS
authors.lastname: Carvalho
authors.affiliation: Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil. vitoraze8@gmail.com.
authors.forename: Vitor Manuel Pereira
authors.initials: VM
authors.lastname: Azevedo
authors.affiliation: Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil. chavesr@uol.com.br.
authors.forename: Rogério Brant Martins
authors.initials: RB
authors.lastname: Chaves
authors.affiliation: School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. l.hashimoto@globo.com.
authors.forename: Lucas de Aquino
authors.initials: Lde A
authors.lastname: Hashimoto
authors.affiliation: School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. carolxavier@uol.com.br.
authors.forename: Carolina de Aquino
authors.initials: Cde A
authors.lastname: Xavier
authors.affiliation: Instituto Nacional de Cardiologia - INC (National Institute of Cardiology, Ministry of Health), Coordenação de Ensino e Pesquisa, Divisão de Saúde Coletiva, rua das Laranjeiras 374, Laranjeiras, Rio de Janeiro, RJ, Brazil. aquino1@uol.com.br.
authors.forename: Regina Maria de Aquino
authors.initials: RM
authors.lastname: Xavier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D009202:Cardiomyopathies / Q000401:mortality / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000628:therapy*; D002423:Cause of Death; D002598:Chagas Cardiomyopathy / Q000401:mortality / Q000628:therapy; D002648:Child; D017147:Defibrillators, Implantable; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D055815:Young Adult