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Impact of Optimized Medical Therapy on ICD Shocks and Survival in Heart Failure Patients
Session:
SESSÃO DE POSTERS 49 - RESSINCRONIZAÇÃO CARDÍACA E TERAPÊUTICA MÉDICA
Speaker:
Patrícia Bernardes
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Patrícia Bernardes; Sara Gonçalves; Jéni Quintal; Rita Marinheiro; Dinis Mesquita; Leonor Parreira; Filipe Seixo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Implantable cardioverter-defibrillators (ICDs) are a cornerstone in preventing sudden cardiac death in pts with heart failure with reduced ejection fraction (HFrEF). Over the past decade, optimized medical therapy (OMT), including the introduction ARNIs and SGLT2 inhibitors, have significantly improved outcomes. However, the impact of these therapies on the incidence of appropriate ICD shocks (AS) and pts survival remains insufficiently studied.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To compare the incidence of appropriate ICD shocks and overall survival between two cohorts of ischemic HFrEF pts with an ICD implanted: the <em>Old Era</em> group (treated before the widespread use of ARNIs and iSGLT2, 2012–2017) and the <em>New Era</em> group (treated after their introduction, 2017–2022, and the creation of an HF outpatient clinic).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>A retrospective observational study was conducted, including pts with HFrEF who underwent ICD implantation between 2012 and 2022. Pts were divided into two groups: <em>Old Era</em> (2012–2017) and <em>New Era</em> (2017–2022). Data on ICD therapy, survival, and baseline characteristics were collected.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong><br /> This cohort included 354 pts with a mean age of 63.3 years (SD= 10.9) and 78% male predominance. The mean follow-up was 27 months (±19), with 71% of pts having a current NYHA status of II and a mean ejection fraction (EF) of 28.6% (±6.8). Cardiovascular comorbidities were prevalent, including hypertension (82%), dyslipidemia (78%), and obesity (39%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The frequency of AS was significantly lower in the <em>New Era</em> group (14.9%, n=31) compared to the <em>Old Era</em> group (35.6%, n=52; p < 0.001). Kaplan-Meier analysis showed a delayed onset of the first AS in the<em> New Era</em> group, with a median time to first shock of 19 months vs. 10 months in the <em>Old Era</em> group (<em>p =</em> 0.001, log-rank test).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The <em>New Era</em> group exhibited improved overall survival, with a 5-year survival rate of 75% compared to 51% in the <em>Old Era</em> group (<em>HR</em> = 0.43, 95% CI 0.29–0.62, <em>p</em> = 0.001). This survival benefit was consistent across various subgroups, including age, diabetes, and baseline EF.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After adjusting for potential confounders, OMT in <em>New Era</em> group was independently associated with a 66% lower risk of AS (<em>adjusted HR</em> = 0.34, 95% CI 0.20–0.59, <em>p</em> = 0.001) and a 59% lower risk of death (<em>adjusted HR</em> = 0.41, 95% CI 0.25–0.65, <em>p</em> = 0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>A multidisciplinary HF outpatient team and the implementation of OMT in ischemic HFrEF significantly reduced the frequency of appropriate ICD shocks and improved pts survival. </span></span></p>
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