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KMID : 0191120200350460397
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Journal of Korean Medical Science
2020 Volume.35 No. 46 p.397 ~ p.397
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Implantable Cardioverter-defibrillator Utilization and Its Outcomes in Korea: Data from Korean Acute Heart Failure Registry
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Cho Young-Jin
Cho Sang-Yeong
Oh Il-Young
Lee Ji-Hyun
Park Jin-Joo
Lee Hae-Young
Kim Kye-Hun
Yoo Byung-Su
Kang Seok-Min
Baek Sang-Hong
Jeon Eun-Seok
Kim Jae-Joong
Cho Myeong-Chan
Chae Shung-Chull
Oh Byung-Hee
Choi Dong-Ju
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Abstract
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Background: There are sparse data on the utilization rate of implantable cardioverter-defibrillator (ICD) and its beneficial effects in Korean patients with heart failure with reduced left ventricular ejection fraction (LVEF).
Methods: Among 5,625 acute heart failure (AHF) patients from 10 tertiary university hospitals across Korea, 485 patients with reassessed LVEF ≤ 35% at least 3 months after the index admission were enrolled in this study. The ICD implantation during the follow-up was evaluated. Mortality was compared between patients with ICDs and age-, sex-, and follow-up duration matched control patients.
Results: Among 485 patients potentially indicated for an ICD for primary prevention, only 56 patients (11.5%) underwent ICD implantation during the follow-up. Patients with ICD showed a significantly lower all-cause mortality compared with their matched control population: adjusted hazard ratio (HR) (95% confidence interval [CI]) = 0.39 (0.16?0.92), P = 0.032. The mortality rate was still lower in the ICD group after excluding patients with cardiac resynchronization therapy (adjusted HR [95% CI] = 0.09 [0.01?0.63], P = 0.015). According to the subgroup analysis for ischemic heart failure, there was a significantly lower all-cause mortality in the ICD group than in the no-ICD group (HR [95% CI] = 0.20 [0.06?0.72], P = 0.013), with a borderline statistical significance (interaction P = 0.069).
Conclusion: Follow-up data of this large, multicenter registry suggests a significant under-utilization of ICD in Korean heart failure patients with reduced LVEF. Survival analysis implies that previously proven survival benefit of ICD in clinical trials could be extrapolated to Korean patients.
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KEYWORD
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Implantable Cardioverter-defibrillator, Heart Failure
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