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).

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Citation: Heart Rhythm. 11(8):1377-83, 2014 Aug.PMID: 24793459Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleSubject headings: *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]Local holdings: Available online through MWHC library: 2004 - presentISSN:
  • 1547-5271
Name of journal: Heart rhythm : the official journal of the Heart Rhythm SocietyAbstract: 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.All authors: Blasco-Colmenares E, Butcher B, Cheng A, Dickfeld T, Eldadah Z, Ellenbogen KA, Guallar E, Kennedy R, Marine JE, Norgard S, Tomaselli GF, Zhang YDigital Object Identifier: Date added to catalog: 2015-06-03
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Journal Article MedStar Authors Catalog Article Available 24793459

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.

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