title: Temporal Trends Over a Decade of Defibrillator Therapy for Primary Prevention in Community Practice.
abstract: BACKGROUND
  Technology and clinical practice surrounding the use of the primary prevention implantable cardioverter defibrillator (ICD) are in a state of constant evolution. The purpose of the study was to test the hypothesis of significant temporal trends in characteristics and outcomes over a decade of ICD therapy.
  
  
  METHODS
  Between 2002 and 2012, 5,539 consecutive patients (age 62.5 ± 11 years, 84.9% male), with ischemic or nonischemic cardiomyopathy, implanted with a primary prevention ICD from 12 centers in France were included. Information on characteristics and outcomes (including causes of death) were evaluated over a median follow-up of 994 days (466-1,667).
  
  
  RESULTS
  In addition to a shift in the type of devices implanted with a significant increase in cardiac resynchronization therapy-defibrillator (CRT-D) over time (43.6 to 60.4%, P = 0.0001), an increase in mean age (from 61.5 ± 11.6 to 63.2 ± 10.9 years, P = 0.0016), proportion of nonischemic cardiomyopathy (31.0 to 44.7%, P <0.0001) and women recipients (11.4 to 15.8%, P = 0.004) was observed. A total of 1,181 patients (22.3%) received ≥1 appropriate therapy, inappropriate therapies occurred in 355 patients (6.7%) and 826 patients (15.2%) died, mainly from cardiovascular causes (49.3%). Annual mortality incidence (5.4% to 4.3%, P = 0.05), as well as incidence of appropriate therapy (10.4% to 7.1%, P = 0.0004), significantly decreased over the decade. By contrast, incidence of ICD-related late (>30 days after implant) complications significantly increased (4.6 to 7.6%, P = 0.003).
  
  
  CONCLUSIONS
  Our findings demonstrate significant changes in patterns of use and outcomes in primary prevention ICD over the last decade with reductions in mortality and appropriate therapies, counterbalanced by an increase in complications.
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.affiliation: Paris Cardiovascular Research Center (Inserm U970), Paris, France.
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: IRSN, Laboratory of Epidemiology, Fontenay-aux-Roses, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jacob
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Rui
authors.initials: R
authors.lastname: Providencia
authors.affiliation: CHU Antoine Béclère, Clamart, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Algalarrondo
authors.affiliation: Paris Cardiovascular Research Center (Inserm U970), Paris, France.
authors.forename: Abdeslam
authors.initials: A
authors.lastname: Bouzeman
authors.affiliation: Paris Cardiovascular Research Center (Inserm U970), Paris, France.
authors.forename: Frankie
authors.initials: F
authors.lastname: Beganton
authors.affiliation: CHU Michallon, Grenoble, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.affiliation: Paris Cardiovascular Research Center (Inserm U970), Paris, France.
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Perier
authors.affiliation: CHU Brabois, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.affiliation: Centre Cardiologique du Nord, Saint Denis, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Piot
authors.affiliation: CHRU Lille, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: Nouvelles Cliniques Nantaises, Nantes, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gras
authors.affiliation: CHU Trousseau, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: CHU Haut Lévêque, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.affiliation: CHU Trousseau, Tours, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
authors.affiliation: CHU La Timone, Marseille, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.affiliation: CHU Pontchaillou, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: Paris Cardiovascular Research Center (Inserm U970), Paris, France.|European Georges Pompidou Hospital, Paris, France.|Paris Descartes University, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003153:Community Health Services / Q000639:trends*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000639:trends*; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality / Q000639:trends*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011322:Primary Prevention / Q000295:instrumentation / Q000639:trends*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: implantable cardioverter defibrillator; sudden cardiac death; sudden death prevention