Abstract 12432: Temporal Trends over a Decade of Defibrillator Therapy for Primary Prevention in Community Practice
Aims: Technology and clinical practice surrounding the use of the primary prevention implantable cardioverter defibrillator (ICD) are in a state of constant evolution. Using a multicenter national registry, we evaluated temporal trends in characteristics and outcomes over a decade of ICD therapy.
Methods and Results: Between 2002-2012, 5,539 consecutive patients (age 62.5±11 years, 84.9% male, 60.2% with coronary artery disease) implanted with a primary prevention ICD from 12 centers in France were enrolled. Information on characteristics and outcomes (including causes of death) were evaluated over a median follow-up of 994 days [466-1,667]. In addition to a shift in the type of devices implanted with a significant increase in cardiac resynchronization therapy-defibrillator (CRT-D) over time (43.6 to 60.4%, P=0.0001), an increase in mean age (from 61.5±11.6 to 63.2±10.9 years, P=0.0016), proportion of non-ischemic cardiomyopathy (31.0 to 44.7%, P<0.0001) and women recipients (11.4 to 15.8%, P=0.004) was observed. A total of 1,181 patients (22.3%) received ≥1 appropriate therapy, inappropriate therapies occurred in 355 patients (6.7%) and 826 patients (15.2%) died mainly from cardiovascular cause (407 patients corresponding to 49.3%). Annual mortality incidence (5.4 to 4.3%, P=0.05) and annual incidence of appropriate therapy (10.4 to 7.1%, P=0.0004, Figure) significantly decreased over the decade. By contrast, incidences of ICD-related complications increased over the decade (4.6 to 7.6%, P=0.003).
Conclusion: Our findings demonstrate significant changes in patterns of use and outcomes in primary prevention ICD over the last decade with reductions in mortality, appropriate therapies, associated with an increase in complications.
Author Disclosures: E. Marijon: None. R. Providência: None. A. Bouzeman: None. V. Algalarrondo: None. K. Narayanan: None. P. Defaye: None. N. Sadoul: None. O. Piot: None. D. Klug: None. D. Gras: None. L. Fauchier: None. P. Bordachar: None. D. Babuty: None. J. Deharo: None. C. Leclercq: None. S. Boveda: None.
- © 2015 by American Heart Association, Inc.