Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial

for the WARCEF Investigators

Research output: Contribution to journalArticle

Abstract

Aims: There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Methods and results: We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131). Conclusions: The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.

Original languageEnglish (US)
JournalESC Heart Failure
DOIs
StatePublished - Jan 1 2019

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Implantable Defibrillators
Warfarin
Cardiomyopathies
Aspirin
Heart Failure
Mortality
Confidence Intervals
Propensity Score
Proportional Hazards Models
Cause of Death

Keywords

  • Heart failure with reduced ejection fraction
  • Implantable cardioverter-defibrillator
  • Non-ischaemic cardiomyopathy
  • Propensity score matching

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{754fcfb3d78240fe98c49442163d6a37,
title = "Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial",
abstract = "Aims: There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Methods and results: We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95{\%} confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95{\%} confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131). Conclusions: The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.",
keywords = "Heart failure with reduced ejection fraction, Implantable cardioverter-defibrillator, Non-ischaemic cardiomyopathy, Propensity score matching",
author = "{for the WARCEF Investigators} and Lee, {Tetz C.} and Min Qian and Lan Mu and {Di Tullio}, {Marco R.} and Susan Graham and Mann, {Douglas L.} and Koki Nakanishi and Teerlink, {John R.} and Lip, {Gregory Y.H.} and Freudenberger, {Ronald S.} and Sacco, {Ralph L} and Mohr, {Jay P.} and Labovitz, {Arthur J.} and Piotr Ponikowski and Lok, {Dirk J.} and Conrado Estol and Anker, {Stefan D.} and Pullicino, {Patrick M.} and Richard Buchsbaum and Bruce Levin and Thompson, {John L.P.} and Shunichi Homma and Siqin Ye",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/ehf2.12407",
language = "English (US)",
journal = "ESC heart failure",
issn = "2055-5822",
publisher = "The Heart Failure Association of the European Society of Cardiology",

}

TY - JOUR

T1 - Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure

T2 - a propensity-matched analysis of the WARCEF trial

AU - for the WARCEF Investigators

AU - Lee, Tetz C.

AU - Qian, Min

AU - Mu, Lan

AU - Di Tullio, Marco R.

AU - Graham, Susan

AU - Mann, Douglas L.

AU - Nakanishi, Koki

AU - Teerlink, John R.

AU - Lip, Gregory Y.H.

AU - Freudenberger, Ronald S.

AU - Sacco, Ralph L

AU - Mohr, Jay P.

AU - Labovitz, Arthur J.

AU - Ponikowski, Piotr

AU - Lok, Dirk J.

AU - Estol, Conrado

AU - Anker, Stefan D.

AU - Pullicino, Patrick M.

AU - Buchsbaum, Richard

AU - Levin, Bruce

AU - Thompson, John L.P.

AU - Homma, Shunichi

AU - Ye, Siqin

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Methods and results: We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131). Conclusions: The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.

AB - Aims: There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Methods and results: We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131). Conclusions: The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.

KW - Heart failure with reduced ejection fraction

KW - Implantable cardioverter-defibrillator

KW - Non-ischaemic cardiomyopathy

KW - Propensity score matching

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U2 - 10.1002/ehf2.12407

DO - 10.1002/ehf2.12407

M3 - Article

C2 - 30816013

AN - SCOPUS:85062370582

JO - ESC heart failure

JF - ESC heart failure

SN - 2055-5822

ER -