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The mortality analysis of primary prevention patients receiving a cardiac resynchronization defibrillator (CRT-D) or implantable cardioverter defibrillator (ICD) according to guideline indications in the Improve SCA Study.
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  • Chi Keong Ching,
  • Yu-Cheng Hsieh,
  • Yen-Bin Liu,
  • Diego Rodriguez,
  • Young-Hoon Kim,
  • Boyoung Joung,
  • Balbir Singh,
  • Dejia Huang,
  • Azlan Hussin,
  • Alexander Chasnoits,
  • Janet OBrien,
  • Jeffrey Cerkvenik,
  • Daniel Lexcen,
  • Brian Van Dorn ,
  • Shu Zhang
Chi Keong Ching
National Heart Centre Singapore
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Yu-Cheng Hsieh
Cardiovascular center
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Yen-Bin Liu
Cardiovascular Center and Division of Cardiology
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Diego Rodriguez
Fundacion Cardioinfantil Instituto de Cardiologia
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Young-Hoon Kim
Korea University Medical Centrer
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Boyoung Joung
Yonsei Cardiovascular Center and Cardiovascular Research
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Balbir Singh
Medanta The Medicity
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Dejia Huang
West China Hospital of Medicine
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Azlan Hussin
National Heart Institute
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Alexander Chasnoits
Republican Scientific Practical Centre Cardiology
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Janet OBrien
Medtronic Operational Headquarters
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Jeffrey Cerkvenik
Medtronic
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Daniel Lexcen
Medtronic plc
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Brian Van Dorn
Medtronic Operational Headquarters
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Shu Zhang
Fuwai hospital and cardiovascular institute, Chinese Academy of Medical Sciences, Peking Union Medical College
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Abstract

Background: Despite a proven mortality benefit in primary prevention (PP) patients, the utilization of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy-defibrillators (CRT-D) remains low in many geographies. Purpose: The objective of this analysis was to examine the mortality benefit in PP patients by guideline-indicated device type: implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D). Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from regions where ICD utilization is low. PP patient’s CRT-D or ICD eligibility was based upon the 2008 ACC/AHA/HRS and 2006 ESC guidelines. Mortality was assessed according to guideline-indicated device type comparing implanted and non-implanted patients. Cox proportional hazards methods were used, adjusting for known factors affecting mortality risk. Results: Among 2,618 PP patients followed for a mean of 20.8 ± 10.8 months, 1,073 were indicated for a CRT-D, and 1,545 were indicated for an ICD. PP CRT-D-indicated patients who received CRT-D therapy had a 58% risk reduction in mortality compared to those without implant (adjusted HR 0.42, 95% CI: 0.28-0.61, P<0.0001). PP patients with an ICD indication had a 43% risk reduction in mortality with an ICD implant compared with no implant (adjusted HR 0.57, 95% CI: 0.41-0.81, P=0.002). Conclusions: This analysis confirms the mortality benefit of adherence to guideline-indicated implantable defibrillation therapy for PP patients in geographies where ICD therapy was underutilized. These results affirm that medical practice should follow clinical guidelines when choosing therapy for PP patients who meet the respective defibrillator device implant indication.

Peer review status:UNDER REVIEW

07 Apr 2021Submitted to Journal of Cardiovascular Electrophysiology
10 Apr 2021Assigned to Editor
10 Apr 2021Submission Checks Completed
22 Apr 2021Reviewer(s) Assigned
06 May 2021Review(s) Completed, Editorial Evaluation Pending