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Predicting appropriate shocks in patients with heart failure: Patient level meta‐analysis from SCD‐HeFT and MADIT II
Author(s) -
Zeitler Emily P.,
AlKhatib Sana M.,
Friedman Daniel J.,
Han Joo Yoon,
Poole Jeanne E.,
Bardy Gust H.,
Bigger J. Thomas,
Buxton Alfred E.,
Moss Arthur J.,
Lee Kerry L.,
Dorian Paul,
Cappato Riccardo,
Kadish Alan H.,
Kudenchuk Peter J.,
Mark Daniel B.,
Inoue Lurdes Y. T.,
Sanders Gillian D.
Publication year - 2017
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13307
Subject(s) - medicine , meta analysis , cardiology , heart failure
Background No precise tools exist to predict appropriate shocks in patients with a primary prevention ICD. We sought to identify characteristics predictive of appropriate shocks in patients with a primary prevention implantable cardioverter defibrillator (ICD). Methods Using patient‐level data from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD‐HeFT), we identified patients with any appropriate shock. Clinical and demographic variables were included in a logistic regression model to predict appropriate shocks. Results There were 1,463 patients randomized to an ICD, and 285 (19%) had ≥1 appropriate shock over a median follow‐up of 2.59 years. Compared with patients without appropriate ICD shocks, patients who received any appropriate shock tended to have more severe heart failure. In a multiple logistic regression model, predictors of appropriate shocks included NYHA class (NYHA II vs. I: OR 1.65, 95% CI 1.07–2.55; NYHA III vs. I: OR 1.74, 95% CI 1.10–2.76), lower LVEF (per 1% change) (OR 1.04, 95% CI 1.02–1.06), absence of beta‐blocker therapy (OR 1.61, 95% CI 1.23–2.12), and single chamber ICD (OR 1.67, 95% CI 1.13–2.45). Conclusion In this meta‐analysis of patient level data from MADIT‐II and SCD‐HeFT, higher NYHA class, lower LVEF, no beta‐blocker therapy, and single chamber ICD (vs. dual chamber) were significant predictors of appropriate shocks.