Outcomes in African Americans undergoing cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: findings from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD).
Outcomes in African Americans undergoing cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: findings from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD).
Available online through MWHC library: 2004 - present
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) reduce the risk of death in patients with left ventricular dysfunction. Little is known regarding the benefit of this therapy in African Americans (AAs). CONCLUSION: In patients with primary prevention ICDs, AAs had an increased risk of dying without receiving an appropriate ICD shock compared to non-AAs.Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. METHODS: We conducted a prospective cohort study of patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end-point was appropriate ICD shock defined as a shock for rapid ventricular tachyarrhythmias. The secondary end-point was all-cause mortality. OBJECTIVE: The purpose of this study was to determine the association between AA race and outcomes in a cohort of primary prevention ICD patients. RESULTS: There were 1189 patients (447 AAs and 712 non-AAs) enrolled. Over a median follow-up of 5.1 years, a total of 137 patients experienced an appropriate ICD shock, and 343 died (294 of whom died without receiving an appropriate ICD shock). The multivariate adjusted hazard ratio (95% confidence interval) comparing AAs vs non-AAs were 1.24 (0.96-1.59) for all-cause mortality, 1.33 (1.02, 1.74) for all-cause mortality without receiving appropriate ICD shock, and 0.78 (0.51, 1.19) for appropriate ICD shock. Ejection fraction, diabetes, and hypertension appeared to explain 24.1% (10.1%-69.5%), 18.7% (5.3%-58.0%), and 13.6% (3.8%-53.6%) of the excess risk of mortality in AAs, with a large proportion of the mortality difference remaining unexplained.
English
1547-5271
*African Americans
*Death, Sudden, Cardiac/pc [Prevention & Control]
*Defibrillators, Implantable
*Primary Prevention/mt [Methods]
*Risk Assessment
*Ventricular Dysfunction, Left/th [Therapy]
Death, Sudden, Cardiac/ep [Epidemiology]
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Prognosis
Prospective Studies
Risk Factors
United States/ep [Epidemiology]
Ventricular Dysfunction, Left/eh [Ethnology]
Ventricular Dysfunction, Left/pp [Physiopathology]
MedStar Heart & Vascular Institute
Available online through MWHC library: 2004 - present
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) reduce the risk of death in patients with left ventricular dysfunction. Little is known regarding the benefit of this therapy in African Americans (AAs). CONCLUSION: In patients with primary prevention ICDs, AAs had an increased risk of dying without receiving an appropriate ICD shock compared to non-AAs.Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. METHODS: We conducted a prospective cohort study of patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end-point was appropriate ICD shock defined as a shock for rapid ventricular tachyarrhythmias. The secondary end-point was all-cause mortality. OBJECTIVE: The purpose of this study was to determine the association between AA race and outcomes in a cohort of primary prevention ICD patients. RESULTS: There were 1189 patients (447 AAs and 712 non-AAs) enrolled. Over a median follow-up of 5.1 years, a total of 137 patients experienced an appropriate ICD shock, and 343 died (294 of whom died without receiving an appropriate ICD shock). The multivariate adjusted hazard ratio (95% confidence interval) comparing AAs vs non-AAs were 1.24 (0.96-1.59) for all-cause mortality, 1.33 (1.02, 1.74) for all-cause mortality without receiving appropriate ICD shock, and 0.78 (0.51, 1.19) for appropriate ICD shock. Ejection fraction, diabetes, and hypertension appeared to explain 24.1% (10.1%-69.5%), 18.7% (5.3%-58.0%), and 13.6% (3.8%-53.6%) of the excess risk of mortality in AAs, with a large proportion of the mortality difference remaining unexplained.
English
1547-5271
*African Americans
*Death, Sudden, Cardiac/pc [Prevention & Control]
*Defibrillators, Implantable
*Primary Prevention/mt [Methods]
*Risk Assessment
*Ventricular Dysfunction, Left/th [Therapy]
Death, Sudden, Cardiac/ep [Epidemiology]
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Prognosis
Prospective Studies
Risk Factors
United States/ep [Epidemiology]
Ventricular Dysfunction, Left/eh [Ethnology]
Ventricular Dysfunction, Left/pp [Physiopathology]
MedStar Heart & Vascular Institute