Prognostic importance of defibrillator shocks in patients with heart failure

Jeanne E. Poole, George W. Johnson, Anne S. Hellkamp, Jill Anderson, David J. Callans, Merritt H. Raitt, Ramakota K. Reddy, Francis E. Marchlinski, Raymond Yee, Thomas Guarnieri, Mario Talajic, David J. Wilber, Daniel P. Fishbein, Douglas L Packer, Daniel B. Mark, Kerry L. Lee, Gust H. Bardy

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Patients with heart failure who receive an implantable cardioverter-defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about longterm prognosis after ICD therapy in such patients is limited. METHODS: Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate. RESULTS: Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P = 0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure. CONCLUSIONS: Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.

Original languageEnglish (US)
Pages (from-to)1009-1017
Number of pages9
JournalNew England Journal of Medicine
Volume359
Issue number10
DOIs
StatePublished - Sep 4 2008

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Defibrillators
Implantable Defibrillators
Shock
Heart Failure
Confidence Intervals
Primary Prevention
Cause of Death
Ventricular Fibrillation
Ventricular Tachycardia
Proportional Hazards Models

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Poole, J. E., Johnson, G. W., Hellkamp, A. S., Anderson, J., Callans, D. J., Raitt, M. H., ... Bardy, G. H. (2008). Prognostic importance of defibrillator shocks in patients with heart failure. New England Journal of Medicine, 359(10), 1009-1017. https://doi.org/10.1056/NEJMoa071098

Prognostic importance of defibrillator shocks in patients with heart failure. / Poole, Jeanne E.; Johnson, George W.; Hellkamp, Anne S.; Anderson, Jill; Callans, David J.; Raitt, Merritt H.; Reddy, Ramakota K.; Marchlinski, Francis E.; Yee, Raymond; Guarnieri, Thomas; Talajic, Mario; Wilber, David J.; Fishbein, Daniel P.; Packer, Douglas L; Mark, Daniel B.; Lee, Kerry L.; Bardy, Gust H.

In: New England Journal of Medicine, Vol. 359, No. 10, 04.09.2008, p. 1009-1017.

Research output: Contribution to journalArticle

Poole, JE, Johnson, GW, Hellkamp, AS, Anderson, J, Callans, DJ, Raitt, MH, Reddy, RK, Marchlinski, FE, Yee, R, Guarnieri, T, Talajic, M, Wilber, DJ, Fishbein, DP, Packer, DL, Mark, DB, Lee, KL & Bardy, GH 2008, 'Prognostic importance of defibrillator shocks in patients with heart failure', New England Journal of Medicine, vol. 359, no. 10, pp. 1009-1017. https://doi.org/10.1056/NEJMoa071098
Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH et al. Prognostic importance of defibrillator shocks in patients with heart failure. New England Journal of Medicine. 2008 Sep 4;359(10):1009-1017. https://doi.org/10.1056/NEJMoa071098
Poole, Jeanne E. ; Johnson, George W. ; Hellkamp, Anne S. ; Anderson, Jill ; Callans, David J. ; Raitt, Merritt H. ; Reddy, Ramakota K. ; Marchlinski, Francis E. ; Yee, Raymond ; Guarnieri, Thomas ; Talajic, Mario ; Wilber, David J. ; Fishbein, Daniel P. ; Packer, Douglas L ; Mark, Daniel B. ; Lee, Kerry L. ; Bardy, Gust H. / Prognostic importance of defibrillator shocks in patients with heart failure. In: New England Journal of Medicine. 2008 ; Vol. 359, No. 10. pp. 1009-1017.
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abstract = "BACKGROUND: Patients with heart failure who receive an implantable cardioverter-defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about longterm prognosis after ICD therapy in such patients is limited. METHODS: Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate. RESULTS: Over a median follow-up period of 45.5 months, 269 patients (33.2{\%}) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95{\%} confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95{\%} CI, 1.29 to 3.05; P = 0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95{\%} CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure. CONCLUSIONS: Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.",
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AU - Poole, Jeanne E.

AU - Johnson, George W.

AU - Hellkamp, Anne S.

AU - Anderson, Jill

AU - Callans, David J.

AU - Raitt, Merritt H.

AU - Reddy, Ramakota K.

AU - Marchlinski, Francis E.

AU - Yee, Raymond

AU - Guarnieri, Thomas

AU - Talajic, Mario

AU - Wilber, David J.

AU - Fishbein, Daniel P.

AU - Packer, Douglas L

AU - Mark, Daniel B.

AU - Lee, Kerry L.

AU - Bardy, Gust H.

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N2 - BACKGROUND: Patients with heart failure who receive an implantable cardioverter-defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about longterm prognosis after ICD therapy in such patients is limited. METHODS: Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate. RESULTS: Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P = 0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure. CONCLUSIONS: Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.

AB - BACKGROUND: Patients with heart failure who receive an implantable cardioverter-defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about longterm prognosis after ICD therapy in such patients is limited. METHODS: Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate. RESULTS: Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P = 0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure. CONCLUSIONS: Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.

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