Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settingsReport as inadecuate




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BMC Cardiovascular Disorders

, 15:22

Non-coronary artery cardiac disease

Abstract

BackgroundThe efficacy of implantable cardioverter-defibrillator ICD and cardiac resynchronization therapy-defibrillator CRT-D therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System SUS.

MethodsAll patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto’s test. Prognostic factors were selected using Cox’s models.

ResultsThere were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas’ heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation 5.3% than those undergoing transvenous implantation 1.6% p = 0.02.

ConclusionsThe results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.

KeywordsImplantable defibrillators Cardiac resynchronization therapy devices Chagas cardiomyopathy Survival analysis Medical record linkage Brazil Database Technology assessment Hospital mortality High-cost technology AbbreviationsICDImplantable cardioverter-defibrillator

CIConfidence interval

CRT-DCardiac resynchronization therapy-defibrillator

EFEjection fraction

HRHazard ratio

NYHANew York Heart Association

SIHBrazilian Hospital Database

SIMBrazilian National Mortality Database

SUSBrazilian National Health System

AIHHospital admission authorization forms

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Author: Arn Migowski - Antonio Luiz Ribeiro - Marilia Sá Carvalho - Vitor Manuel Pereira Azevedo - Rogério Brant Martins Chav

Source: https://link.springer.com/



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