Abstract 14960: Long-Term Survival With Implantable Cardioverter-Defibrillator in Different Symptomatic Functional Classes of Heart Failure
Background: ACC/AHA/HRS guidelines recommend implantable cardioverter-defibrillator (ICD) therapy primary prevention in all patients with severely reduced left ventricular ejection fraction (LVEF ≤30%) regardless of New York Heart Association (NYHA) functional class, whereas recent European guidelines limit the indication to those with symptomatic heart failure (NYHA ≥II). We therefore aimed to evaluate the long-term survival benefit of primary ICD therapy among patients with and without heart failure (HF) symptoms who were enrolled in MADIT-II.
Methods: We classified 1164 MADIT-II patients groups according to the baseline NYHA class (NYHA I [n=442], NYHA II [n=425], and NYHA III [n=297]); patients with NYHA IV were excluded. Multivariate Cox proportional hazards regression modeling was performed to compare the mortality reduction with ICD vs. non-ICD therapy during 8-years of follow-up between the three NYHA groups.
Results: The median (IQR) follow-up time was 7.6 (3.5-9) years. At 8 years of follow-up the cumulative probability of mortality in the non-ICD treatment arm was 57% for NYHA I, 57% for NYHA II and 76% for NYHA III (p<0.001). Multivariate model demonstrated similar long-term mortality risk reduction with ICD as compared with the non-ICD treatment arm regardless of HF symptoms: NYHA I (HR=0.63, 0.46-0.85, p=0.003), NYHA II (HR=0.68, 0.50-0.93, p=0.017) and NYHA III (HR=0.68, 0.50-0.94, p=0.018) p for NYHA class by treatment arm interaction>0.10.
Conclusions: Primary ICD therapy provides consistent long-term survival benefit among patients with severe LV dysfunction, regardless of HF symptoms. These findings do not support the recent exclusion of NYHA Class I patients from ESC guidelines.
Author Disclosures: Y. Biton: None. S. Rosero: None. A. Moss: Research Grant; Significant; grant support from Boston Scientific. W. Zareba: Research Grant; Significant; grant support from Boston Scientific. V. Kutyifa: Research Grant; Significant; grant support from Boston Scientific. A. Barsheshet: Research Grant; Modest; Zoll. S. Mcnitt: None. B. Polonsky: None. I. Goldenberg: Research Grant; Significant; grant support from Boston Scientific.
- © 2016 by American Heart Association, Inc.