title: Characteristics and outcomes of diabetic patients with an implantable cardioverter defibrillator in a real world setting: results from the Israeli ICD registry.
abstract: There are limited data regarding the effect of diabetes mellitus (DM) on the risks of both appropriate and inappropriate implantable cardioverter defibrillator (ICD) therapy. The present study was designed to compare the outcome of appropriate and inappropriate ICD therapy in patients with or without DM.
  
  
  
  The risk of a first appropriate ICD therapy for ventricular tachyarrhythmias (including anti tachycardia pacing and shock) was compared between 764 DM and 1346 non-DM patients enrolled in the national Israeli ICD registry. We also compared the risks of inappropriate ICD therapy, and death or cardiac hospitalization between diabetic and non-diabetic patients. Diabetic patients were older, were more likely to have ischemic cardiomyopathy, lower ejection fraction, atrial fibrillation, and other co-morbidities. The 3-year cumulative incidence of appropriate ICD therapy was similar in the DM and non-DM groups (12 and 13%, respectively, p = 0.983). Multivariate analysis showed that DM did not affect the risk of appropriate ICD therapy (HR = 1.07, 95% CI 0.78-1.47, p = 0.694) or inappropriate therapy (HR = 0.72, 95% CI 0.42-1.23, p = 0.232). However, DM was associated with a 31% increased risk for death or cardiac hospitalization (p = 0.005). Results were similar in subgroup analyses including ICD and defibrillators with cardiac resynchronization therapy function recipients, primary or secondary prevention indication for an ICD.
  
  
  
  Despite a significant excess of cardiac hospitalizations and mortality in the diabetic population, there was no difference in the rate of ICD treatments, suggesting that the outcome difference is not related to arrhythmias.
authors.affiliation: The Edith Wolfson Medical Center, Holon, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. hillels@wmc.gov.il.|Department of Cardiology, The Edith Wolfson Medical Center, Holon, Israel. hillels@wmc.gov.il.
authors.forename: Hillel
authors.initials: H
authors.lastname: Steiner
authors.affiliation: The Edith Wolfson Medical Center, Holon, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Geist
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Rambam Medical Center, Haifa, Israel.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Suleiman
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Cardiovascular Diabetology Research Foundation, Holon, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
authors.affiliation: Kaplan Medical Center, Rehovot The Hebrew University, Jerusalem, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Swissa
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Cardiovascular Diabetology Research Foundation, Holon, Israel.
authors.forename: Enrique Z
authors.initials: EZ
authors.lastname: Fisman
authors.affiliation: Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Gregory
authors.initials: G
authors.lastname: Golovchiner
authors.affiliation: Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Strasberg
authors.affiliation: Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D015897:Comorbidity; D017147:Defibrillators, Implantable; D048909:Diabetes Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D011446:Prospective Studies; D011475:Prosthesis Failure; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Diabetes mellitus; Heart failure; Implantable cardioverter defibrillator; Outcomes