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Long-term Effect of Angiotensin Receptor-Neprilysin Inhibitors on ICD and CRT-D Therapy Outcomes in Patients with HFrEF
Session:
SESSÃO DE POSTERS 49 - RESSINCRONIZAÇÃO CARDÍACA E TERAPÊUTICA MÉDICA
Speaker:
Inês Ferreira Neves
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.2 Implantable Cardioverter / Defibrillator
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Ferreira Neves; Julien Lopes; Francisco Cardoso; Helder Santos; Guilherme Portugal; Pedro Silva Cunha; Bruno Valente; Ana Lousinha; Rita Moreira; António Gonçalves; Rui Cruz Ferreira; Mário Martins Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong> Among patients (P) with heart failure with reduced ejection fraction (HFrEF) a significant proportion of deaths occur due to ventricular tachyarrhythmias. Implantable cardioverter defibrillators (ICD) are recommended in primary prevention to reduce sudden death and all-cause mortality in these population. For patients who additionally have a QRS duration ≥150 ms or left bundle branch block (LBBB) QRS morphology, cardiac resynchronization therapy with defibrillator (CRT-D) is advised. However, the trials responsible for the inclusion of this recommendation in the guidelines were performed before the clinical use of angiotensin receptor-neprilysin inhibitors (ARNIs). Whether the benefit on survival of implanting a defibrillator device after maintaining current guideline-directed medical therapy (GDMT) is not known. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong> Consecutive P with HFrEF, symptomatic and with LVEF ≤35% after 3 months of GDMT, submitted to ICD or CRT-D for primary prevention at our center between 2015 and 2022 were included. We retrospectively analyzed the time to device therapies in P not medicated with ARNI (group 1) and compared with a cohort of patients medicated with ARNI at the time of implantation (group 2). A Kaplan-Meier survival analysis was used to analyze the effect on incident defibrillator therapies.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> 450 P (78.9% males, 64.2±10.9 years) were included; 319 (70.9%) in group 1 (ICD or CRT-D, not medicated with ARNI) and 131 (29.1%) in group 2 (ICD or CRT-D, medicated with ARNI). The mean follow-up duration was 53.1±29.8 months. The absolute number of ICD therapies did not significantly differ between the groups (odds ratio [OR] 0.968; 95% confidence interval [CI] 0.582-1.609, p value = 0.89).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">In a Kaplan-Meier survival analysis, the mean “free from defibrillator therapies” survival time was longer in the group not medicated with ARNI (97.34 weeks; 95% CI: 92.50–102.19) compared to the ARNI medicated group (63.27 weeks; 95% CI: 57.86–68.67), but the difference in survival distributions was not statistically significant (p = 0.198). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong> In a population with HFrEF submitted to ICD or CRT-D implantation for primary prevention, the incidence of ICD therapies in P medicated with ARNI did not significantly differ from the cohort not medicated with ARNI at implantation. Our results suggest that the benefit of implanting a defibrillator in P with HFrEF and LVEF ≤35% is maintained in the current era of new GDMT with ARNI. </span></span></p>
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