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Background  We sought to examine the mortality impact of appropriate implantable cardioverter defibrillator ( ICD ) therapy between patients who received  ICD  for primary versus secondary prevention purposes.    Methods and Results  From a prospective, population‐based registry, we identified 7020 patients who underwent de novo  ICD  implantation between February 2007 and May 2012 in Ontario, Canada. The primary outcome was all‐cause mortality. We used multivariable Cox proportional hazard modeling to adjust for differences in baseline characteristics and analyzed the mortality impact of first appropriate  ICD  therapy (shock and antitachycardia pacing [ ATP ]) as a time‐varying covariate. There were 1929 (27.5%) patients who received  ICD s for secondary prevention purposes. The median follow‐up period was 5.02 years. Compared with those with secondary prevention  ICD s, patients with primary prevention  ICD s had more medical comorbidities, and lower ejection fraction. Patients who experienced appropriate  ICD  shock or  ATP  had greater risk of death compared with those who did not, irrespective of implant indication. In the primary prevention group, the adjusted hazard ratios of death for appropriate shock and  ATP  were 2.00 (95%  CI : 1.72–2.33) and 1.73 (95%  CI : 1.52–1.97), respectively. In the secondary prevention group, the adjusted hazard ratios of death for appropriate  ICD  shock and  ATP  were 1.46 (95%  CI : 1.20–1.77) and 1.38 (95%  CI : 1.16–1.64), respectively.    Conclusions  Despite having a more favorable clinical profile, occurrence of appropriate  ICD  shock or  ATP  in patients with secondary prevention  ICD s was associated with similar magnitudes of mortality risk as those with primary prevention  ICD s. A heightened degree of care is warranted for all patients who experience appropriate  ICD  shock or  ATP  therapy.

journal of the american heart association

Mortality Implications of Appropriate Implantable Cardioverter Defibrillator Therapy in Secondary Prevention Patients: Contrasting Mortality in Primary Prevention Patients From a Prospective Population‐Based Registry