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Implantable Cardioverter Defibrillators in Heart Failure with Reduced Ejection Fraction: Evaluating Efficacy in the Era of Contemporary Pharmacotherapy
Session:
Comunicações Orais - Sessão 08 - Insuficiência cardíaca: da clínica aos dispositivos
Speaker:
Inês Ferreira Neves
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Ferreira Neves; Julien Lopes; Guilherme Portugal; Rita Teixeira; Pedro Silva Cunha; Bruno Valente; Ana Lousinha; Paulo Osório; Hélder Santos; André Monteiro; Rui Cruz Ferreira; Mário Martins Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Introduction:</span></strong><span style="font-size:10.0pt"> Among patients with Heart Failure with Reduced Ejection Fraction (HFrEF), a significant proportion of deaths occur due to electrical disturbances, including ventricular arrhythmias. Implantable cardioverter defibrillators (ICD) are effective in reverting potentially lethal ventricular tachyarrhythmias and are as such recommended in primary prevention. ICD also reduce the risk of sudden death and all-cause mortality in patients with symptomatic heart failure (HF) and a left ventricular ejection fraction (LVEF) </span><span style="font-size:10.0pt">≤</span><span style="font-size:10.0pt">35%, after at least three months of optimal medical therapy (OMT). However, the ICD trials responsible for the inclusion of these recommendation in the guidelines predate the use of angiotensin receptor-neprilysin inhibitors (ARNIs) and SGLT2 inhibitors. In these patients the benefit of implanting ICDs after OMT with the currently available medication is not known.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Methods: </span></strong><span style="font-size:10.0pt">All patients with symptomatic HFrEF, (New York Heart Association [NYHA] class II-III) and with LVEF </span><span style="font-size:10.0pt">≤</span><span style="font-size:10.0pt">35% after 3 months of OMT who were implanted with ICD for primary prevention at our center between 2015 and 2022 were included. ICD therapies, including Anti Tachycardia Pacing (ATP) and shock were recorded during follow-up. We retrospec</span><span style="font-size:10.0pt">ti</span><span style="font-size:10.0pt">vely analyzed the time to event (ICD therapy) before (group 1) and after (group 2) the generalization of treatment with ARNI and SGLT2 inhibitors. A cox regression model was used with time to event and Kaplan-Meier survival curve was calculated.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Results: </span></strong><span style="font-size:10.0pt">289 patients (82.4% males, age 62±11.3 </span><span style="font-size:9.0pt">[</span><span style="font-size:10.0pt">between 50 and 73 years]) were included, 148 (51.2%) included in group 1 (implantation of ICD before the generalization of ARNI and SGLT2 inhibitors) and 141 48.8%) in group 2 (implantation of ICD in the era of contemporary pharmacotherapy). The median follow-up was 4.15 (IQR 3.85) years. There were no relevant statistically significant differences between the two groups. The number of ICD therapies at one year did not significantly differ between the groups (<em>p value</em> = 0.067). In cox regression, contemporary OMT was not associated with a reduced risk of ICD therapy (hazard ratio [HR] 1.47; 95% confidence interval [CI] 0.82-2.70).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">Conclusion: </span></strong><span style="font-size:10.0pt">The benefit of implanting ICD in patients with HFrEF and LVEF </span><span style="font-size:10.0pt">≤</span><span style="font-size:10.0pt">35% appears to be maintained in the era of OMT including ARNI and SGLT2i.</span></span></span></p>
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