title: Changes in Implantation Patterns and Therapy Rates of Implantable Cardioverter Defibrillators over Time in Ischemic and Dilated Cardiomyopathy Patients.
abstract: BACKGROUND
  Clinical guidelines on implantable cardioverter defibrillator (ICD) therapy changed significantly in the last decades with potential inherent effects on therapy efficacy. We aimed to study therapy rates in time and the association between therapies and mortality.
  
  
  METHODS
  All patients receiving an ICD, primary and secondary prevention, were included in a single-center retrospective registry. Information on first appropriate and inappropriate therapies was documented. Dates of implant were divided in P1: 1996-2001, P2: 2002-2008, and P3: 2009-2014.
  
  
  RESULTS
  A total of 727 patients, 84.9% male-66.4% ischemic cardiomyopathy (ICM)-56% primary prevention-mean follow-up 5.2 ± 4.1 years, were included. There was a shift from secondary to primary prevention indications, from ischemic to non-ICM, and from single chamber to cardiac resynchronization therapy defibrillator devices. The annual 1- and 3-year appropriate shock (AS) rate declined from 29.4% and 15.1% in P1, over 13.3% and 9.2% in P2 to 7.8% and 5.7% in P3 (log-rank P < 0.001), while inappropriate shock (IAS) rates remained unchanged (log-rank P = 0.635). After multivariate regression analysis a higher age at implant, lower left ventricular ejection fraction, history of stroke, diabetes mellitus, intake of loop diuretics or digitalis, higher creatinine, and longer QTc were independent predictors of mortality.
  
  
  CONCLUSIONS
  These changes in clinical practice with a shift to primary prevention and rise in non-ICM implants caused a significant decrease in AS incidence, while IAS remained stable. Receiving AS or IAS was not an independent predictor of mortality in our real-life cohort.
authors.affiliation: Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.|Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Vandenberk
authors.affiliation: Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.|Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Garweg
authors.affiliation: Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Gabor
authors.initials: G
authors.lastname: Voros
authors.affiliation: Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Floré
authors.affiliation: Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Marynissen
authors.affiliation: Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.affiliation: University Medical Center Goettingen, Goettingen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Zabel
authors.affiliation: Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.|Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Ector
authors.affiliation: Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.|Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Rik
authors.initials: R
authors.lastname: Willems
mesh_terms: D017677:Age Distribution; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D002311:Cardiomyopathy, Dilated / Q000401:mortality* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D015995:Prevalence; D019919:Prosthesis Implantation / Q000401:mortality* / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
keywords: appropriate therapies; implantable cardioverter defibrillator; inappropriate therapies; mortality