Author + information
- Vishal Yogin Parikh,
- Kerolos Fahmi,
- Mrugesh Thakkar,
- Kevin Kip,
- Thanh Tran,
- Dany Sayad,
- Michael Fradley,
- Bengt Herweg and
- Sanders Chae
Background: Implantable Cardioverter Defibrillators (ICDs) are effective for primary prevention of sudden death in patients with heart failure and low ejection fraction (EF), especially in ischemic cardiomyopathy. There is conflicting evidence for use of ICD in nonischemic cardiomyopathy.1 Recent data suggests African American (AA) patients may not derive overall mortality benefit from an ICD.2 This study attempts to assess whether the indication for ICD implantation differs between AA and white patients.
Methods: 493 consecutive patients who underwent ICD implantation for primary prevention at a single academic tertiary referral center from 10/1/2011–5/1/2016 were identified. Collection of demographic and clinical data was performed through retrospective chart review. Comparisons of mean scores of continuous variables by race were made by use of analysis of variance, and categorical variables were compared by chi-square analysis.
Results: Of 493 patients, 363 patients (73.6%) were white, 82 (16.6%) were AA, and 48 (9.74%) were Other. AA patients were more likely to have nonischemic cardiomyopathy than white patients (81.7% vs 43.8%, p < 0.0001). White men were more likely to undergo implantation for ischemic cardiomyopathy than AA men, AA women, and white women (p< 0.0001). AA patients were more likely to have hypertension (p = 0.0242) and diabetes (p=0.0003) but less likely to have history of coronary bypass surgery (p<0.0001), percutaneous coronary intervention (p=0.0449), or stroke (p=0.0416).
Conclusions: AA patients who undergo ICD implantation for primary prevention are much more likely to suffer from nonischemic cardiomyopathy than low EF due to prior myocardial infarction. Further research is needed to assess the scope of this observation and whether other therapies may be more beneficial for this particular class of patients.
1 Kober, L, et al. “Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure.” N Engl J Med 375.13 (2016): 1221-230.
2 Zhang, Y, et al. “Outcomes in African Americans Undergoing Cardioverter-Defibrillator Implantation for Primary Prevention of Sudden Cardiac Death: Findings from PROSE-ICD.” Heart Rhythm 11.8 (2014): 1377-383.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 3
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1188-071
- 2017 American College of Cardiology Foundation