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April 23, 2013

Outcome of Patients with Advanced Heart Failure who Receive Device-Based Therapy for Primary Prevention of Sudden Cardiac Death . M. Suleiman , G. Amit , N. Samniah , A. Pekar , S. Ben- Zvi , R. Rosso , N. Gavrielov- Yusim , I. Marai , I. Goldenberg, M. Glikson. April 23, 2013.

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April 23, 2013

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  1. Outcome of Patients with Advanced Heart Failure who Receive Device-Based Therapy for Primary Prevention of Sudden Cardiac Death M. Suleiman, G. Amit, N. Samniah, A. Pekar, S. Ben-Zvi, R. Rosso, N. Gavrielov-Yusim, I. Marai, I. Goldenberg, M. Glikson April 23, 2013

  2. Background • Approximately 50% of deaths among patients with HF are sudden. • The percentage of SCD decreases as NYHA class increases • It is widely believed that patients with more advanced HF symptoms are less likely to die from a VA and therefore would not benefit from ICD implantation • Results of landmark ICD trials were inconsistent Sweeney MO. Pacing ClinElectrophysiol2001;24:871-88. KjekshusJ. Am J Cardiol 1990;65:42I-48I.

  3. Purpose • To examine the effect of HF functional class on the outcome of patients who receive device therapy in a real world setting.

  4. Methods • Israeli ICD Registry Database • Period: Jul 2010-June 2012 • 2108 primary prevention patients • Study end points • Death • Appropriate ICD therapies for VA • Readmission to hospital for HF • The combined endpoints of HF or death, VA or death

  5. Baseline Characteristics

  6. Baseline Characteristics

  7. Baseline Characteristics

  8. Baseline Characteristics

  9. Device implanted P<0.001

  10. Outcomes • 1016 unselected registry patients were prospectively followed for the occurrence of clinical outcomes.

  11. Death o HF in the General Population

  12. Death or HF According to Device Type In ICD recipients In RCTD recipients

  13. Death or VA in the General Population

  14. Change in NYHA class during 1-year of follow-up in the ICD and the CRTD groups

  15. Multivariate analysis: Risk of endpoints by NYHA class ≥III vs. <III

  16. Multivariate analysis: Risk of VA/Death by age category (reference group =age<65)

  17. Main Findings • Of new ICDs and CRTDs implanted in Israel, >50% are in patients >65 yo and >20% in patients >75 yo • Elderly patients • have higher risk profile • more likely to receive CRTD device • > secondary prevention indication

  18. Main Findings • Our data add to and support the existing evidence from previous studies that the association between advanced age and adverse clinical outcomes is attenuated in elderly patients implanted with CRT-D devices.

  19. Main Findings • Elderly patients implanted with ICDs experienced a significant increase in the cumulative probability of the combined end-points of appropriate ICD therapy or death and HF or death • In contrast, the risk of both HF and arrhythmic outcomes was attenuated among elderly patients implanted with CRT-D devices.

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