Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study.

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dc.authoridhttps://orcid.org/0000-0003-3416-5965
dc.authoridhttps://orcid.org/0000-0002-9417-7610
dc.authoridhttps://orcid.org/0000-0003-0224-1433
dc.authoridhttps://orcid.org/0000-0002-2227-6177
dc.authoridhttps://orcid.org/0000-0001-6947-2821
dc.authoridhttps://orcid.org/0000-0002-7068-1599
dc.authoridhttps://orcid.org/0000-0003-0825-1851
dc.authoridhttps://orcid.org/0000-0001-8104-6198
dc.authoridhttps://orcid.org/0000-0002-8169-8628
dc.contributor.authorSahin, Anil
dc.contributor.authorCelik, Ahmet
dc.contributor.authorUral, Dilek
dc.contributor.authorColluoglu, Inci Tugce
dc.contributor.authorAta, Naim
dc.contributor.authorKanik, Emine Arzu
dc.contributor.authorUlgu, Mustafa Mahir
dc.contributor.authorBirinci, Suayip
dc.contributor.authorYilmaz, Mehmet Birhan
dc.date.accessioned2024-12-30T13:53:54Z
dc.date.available2024-12-30T13:53:54Z
dc.date.issued2024-11-18
dc.departmentFakülteler, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü
dc.description.abstractIn the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients. Methods: Utilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality. Results: In the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4%) in the GDMT group and 101 out of 619 patients (16.3%) in the ICD group, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) ranging from 0.57 to 0.98. The median follow-up time was 1365 days in the matched cohort, 1283 days in the GDMT group. Subgroup analyses consistently demonstrated benefits, particularly among individuals aged 61 years and older (HR: 0.60, 95% CI: 0.42–0.87, p = 0.006), those with sinus rhythm (HR: 0.55, 95% CI: 0.34–0.89, p = 0.013), individuals not using amiodarone (HR: 0.61, 95% CI: 0.42–0.89, p = 0.011), and those with an estimated glomerular filtration rate lower than 61.9 (HR: 0.66, 95% CI: 0.48–0.91, p = 0.011). Conclusions: This study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF. Graphical Abstract: (Figure presented.)
dc.identifier.citationSahin, A., Celik, A., Ural, D., Colluoglu, I. T., Ata, N., Kanik, E. A., Ulgu, M. M., Birinci, S., & Yilmaz, M. B. (2024). Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study. BMC medicine, 22(1), 539. https://doi.org/10.1186/s12916-024-03761-w
dc.identifier.doi10.1186/s12916-024-03761-w
dc.identifier.issn1741-7015
dc.identifier.issue1
dc.identifier.pmid39551747
dc.identifier.scopus2-s2.0-85209592382
dc.identifier.scopusqualityQ1
dc.identifier.urihttps://doi.org/10.1186/s12916-024-03761-w
dc.identifier.urihttps://hdl.handle.net/20.500.14619/14939
dc.identifier.volume22
dc.identifier.wosWOS:001357244500002
dc.identifier.wosqualityQ1
dc.indekslendigikaynakPubMed
dc.indekslendigikaynakScopus
dc.indekslendigikaynakWeb of Science
dc.language.isoen
dc.publisherSpringer Nature
dc.relation.ispartofBMC Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectImplantable cardioverter-defibrillator
dc.subjectMortality
dc.subjectQuadruple guideline-directed medical therapy
dc.titleImpact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study.
dc.typeArticle

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