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The association between implantable defibrillators and all-cause mortality in left ventricular assist device carriers - initial results of a propensity score adjusted analysis

Session Patient management - From oral treatment to transplant

Speaker Assistant Professor Maja Cikes

Congress : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Ventricular Assist Devices
  • Session type : Rapid Fire Abstracts
  • FP Number : 1549

Authors : M Cikes (Zagreb,HR), N Jakus (Zagreb,HR), JJ Brugts (Rotterdam,NL), P Rubis (Krakow,PL), G Burneikaite (Vilnius,LT), E Van Craenenbroeck (Antwerp,BE), AC Pouleur (Brussels,BE), E Barge-Caballero (A Coruña,ES), A Gkouziouta (Athens,GR), D D'amario (Rome,IT), S Grundmann (Freiburg-Bad Krozingen,DE), LH Lund (Stockholm,SE), A Flammer (Zurich,CH), D Milicic (Zagreb,HR), F Ruschitzka (Zurich,CH)

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Authors:
M Cikes1 , N Jakus1 , JJ Brugts2 , P Rubis3 , G Burneikaite4 , E Van Craenenbroeck5 , AC Pouleur6 , E Barge-Caballero7 , A Gkouziouta8 , D D'amario9 , S Grundmann10 , LH Lund11 , A Flammer12 , D Milicic1 , F Ruschitzka12 , 1University of Zagreb School of Medicine, Department of Cardiovascular Diseases - Zagreb - Croatia , 2Erasmus Medical Center - Rotterdam - Netherlands , 3John Paul II Hospital - Krakow - Poland , 4Vilnius University Hospital - Vilnius - Lithuania , 5University Hospital Antwerp - Antwerp - Belgium , 6Cliniques Saint-Luc UCL, Division of Cardiology - Brussels - Belgium , 7Hospital Universitario de A Coruña - A Coruña - Spain , 8Onassis Cardiac Surgery Center - Athens - Greece , 9Catholic University of the Sacred Heart - Rome - Italy , 10Universitäts-Herzzentrum - Freiburg-Bad Krozingen - Germany , 11Karolinska Institute, Department of Medicine - Stockholm - Sweden , 12University Hospital Zurich, Clinic for Cardiology - Zurich - Switzerland ,

On behalf: The PCHF VAD-ICD/CRT Registry

Citation:

Introduction: The role of multiple devices frequently implanted in patients with advanced heart failure requires further insight from diverse patient cohorts. We have formed a registry of ventricular assist device (VAD) carriers through a network of European heart failure centres, aiming to investigate the association between implantable defibrillator and all cause death in VAD recipients. 

Methods: At current, the registry includes data on 246 patients with continuous flow LVADs (median age 56 (IQR 48-63), 83% male), 63% of which also received an ICD or CRT-D. We created a propensity score to determine the possibility of having an ICD/CRT-D. This was followed by a propensity score adjusted analysis to assess the relation of ICD or CRT-D device carrier status and the occurrence of the primary event of all-cause death. The median follow-up time was 1.3 years (IQR 0.4-2.0) from index date, defined as time of LVAD or ICD/CRT-D implant, whichever came later.

Results: The baseline characteristics varied significantly according to ICD/CRT-D carrier status (Table 1). The rate of all-cause death was significantly lower in ICD/CRT-D carriers (14.0 (9.8-19.9) vs 31.6 (22.8-43.8) per 100 patient-years) as was the crude hazard ratio for all-cause death (0.43 (0.27-0.71), p=0.001). After propensity score adjustment for 17 baseline characteristics, the relative risk of all-cause death remained significantly reduced in ICD/CRT-D carriers (HR 0.30 (0.16-0.57), p<0.0001), even after additional adjusting for CRT-P carrier status (HR 0.27 (0.14-0.52), p<0.0001). 

Conclusion: The initial results from our registry suggest that ICD/CRT-D might be associated with reduced all-cause death in VAD carriers.

No ICD/CRT-D

(N=90)

ICD/CRT-D

(N=156)
Group P-value
Age at implant, years 50±13 56±10 <0.001
Male gender, n (%) 69 (76.7%) 134 (85.9%) 0.07
INTERMACS class 1, n (%) 24 (27.3%) 13 (8.4%) <0.001
INTERMACS class 2, n (%) 24 (27.3%) 33 (21.3%)
INTERMACS class 3, n (%) 19 (21.6%) 61 (39.4%)
INTERMACS class 4-7, n (%) 21 (23.9%) 48 (31.0%)
MCS prior to VAD, n (%) 40 (44.4%) 27 (17.3%) <0.001
VAD type - HMII, n (%) 56 (62.2%) 66 (42.6%) 0.008
VAD type - HW, n (%) 16 (17.8%) 47 (30 3%)
VAD type - HM3, n (%) 15 (16.7%) 41 (26.5%)
VAD type - Other, n (%) 3 (3.3%) 1 (0.6%)
Baseline characteristics of patients according to ICD/CRT-D carrier status.

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