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.