TY - JOUR

T1 - Effect of Implantable Cardioverter-defibrillators in Nonischemic Heart Failure According to Background Medical Therapy

T2 - Extended Follow-up of the DANISH Trial

AU - YAFASOVA, ADELINA

AU - DOI, SEIKO N.

AU - THUNE, JENS JAKOB

AU - NIELSEN, JENS C.

AU - HAARBO, J. E.N.S.

AU - BRUUN, NIELS E.

AU - GUSTAFSSON, F. I.N.N.

AU - EISKJÆR, H. A.N.S.

AU - HASSAGER, CHRISTIAN

AU - SVENDSEN, JESPER H.

AU - HØFSTEN, DAN E.

AU - TORP-PEDERSEN, CHRISTIAN

AU - PEHRSON, STEEN

AU - KØBER, L. A.R.S.

AU - BUTT, JAWAD H.

N1 - Publisher Copyright: © 2024 Elsevier Inc.

PY - 2024

Y1 - 2024

N2 - Background: The Heart Failure Collaboratory (HFC) score integrates types and dosages of guideline-directed pharmacotherapies for heart failure (HF) with reduced ejection fraction (HFrEF). We examined the effects of cardioverter-defibrillator (ICD) implantation according to the modified HFC (mHFC) score in 1116 patients with nonischemic HFrEF from the Danish Study to Assess the Efficacy of ICDs in Patients with Nonischemic Systolic HF on Mortality (DANISH). Methods and Results: Patients were assigned scores for renin-angiotensin-system inhibitors, beta-blockers and mineralocorticoid receptor antagonists (0, no use; 1, < 50% of maximum dosage; 2, ≥ 50% of maximum dosage). The maximum score was 6, corresponding to ≥ 50% of maximum dosage for all therapies. The median baseline mHFC score was 4, and the median follow-up was 9.5 years. Compared with an mHFC score of 3–4, an mHFC score of 1–2 was associated with a higher rate of all-cause death (mHFC = 1–2: adjusted HR 1.67 [95% CI, 1.23–2.28]; mHFC = 3–4, reference; mHFC = 5–6: adjusted HR 1.07 [95% CI, 0.87–1.31]). ICD implantation did not reduce all-cause death compared with control (reference) (HR 0.89 [95% CI, 0.74–1.08]), regardless of mHFC score (mHFC = 1–2: HR 0.98 [95% CI, 0.56–1.71]; mHFC = 3-4: HR 0.89 [95% CI,0.66–1.20]; mHFC = 5–6: HR 0.85 [95% CI, 0.64–1.12]; Pinteraction, 0.65). Similarly, ICD implantation did not reduce cardiovascular death (HR 0.87 [95% CI, 0.70–1.09]), regardless of mHFC score (Pinteraction, 0.59). The ICD group had a lower rate of sudden cardiovascular death (HR, 0.60 [95% CI,0.40–0.92]); this association was not modified by mHFC score (Pinteraction, 0.35). Conclusions: Lower mHFC scores were associated with higher rates of all-cause death. ICD implantation did not result in an overall survival benefit in patients with nonischemic HFrEF, regardless of mHFC score.

AB - Background: The Heart Failure Collaboratory (HFC) score integrates types and dosages of guideline-directed pharmacotherapies for heart failure (HF) with reduced ejection fraction (HFrEF). We examined the effects of cardioverter-defibrillator (ICD) implantation according to the modified HFC (mHFC) score in 1116 patients with nonischemic HFrEF from the Danish Study to Assess the Efficacy of ICDs in Patients with Nonischemic Systolic HF on Mortality (DANISH). Methods and Results: Patients were assigned scores for renin-angiotensin-system inhibitors, beta-blockers and mineralocorticoid receptor antagonists (0, no use; 1, < 50% of maximum dosage; 2, ≥ 50% of maximum dosage). The maximum score was 6, corresponding to ≥ 50% of maximum dosage for all therapies. The median baseline mHFC score was 4, and the median follow-up was 9.5 years. Compared with an mHFC score of 3–4, an mHFC score of 1–2 was associated with a higher rate of all-cause death (mHFC = 1–2: adjusted HR 1.67 [95% CI, 1.23–2.28]; mHFC = 3–4, reference; mHFC = 5–6: adjusted HR 1.07 [95% CI, 0.87–1.31]). ICD implantation did not reduce all-cause death compared with control (reference) (HR 0.89 [95% CI, 0.74–1.08]), regardless of mHFC score (mHFC = 1–2: HR 0.98 [95% CI, 0.56–1.71]; mHFC = 3-4: HR 0.89 [95% CI,0.66–1.20]; mHFC = 5–6: HR 0.85 [95% CI, 0.64–1.12]; Pinteraction, 0.65). Similarly, ICD implantation did not reduce cardiovascular death (HR 0.87 [95% CI, 0.70–1.09]), regardless of mHFC score (Pinteraction, 0.59). The ICD group had a lower rate of sudden cardiovascular death (HR, 0.60 [95% CI,0.40–0.92]); this association was not modified by mHFC score (Pinteraction, 0.35). Conclusions: Lower mHFC scores were associated with higher rates of all-cause death. ICD implantation did not result in an overall survival benefit in patients with nonischemic HFrEF, regardless of mHFC score.

KW - DANISH

KW - Implantable cardioverter-defibrillator

KW - nonischemic heart failure

KW - pharmacotherapy

U2 - 10.1016/j.cardfail.2024.04.017

DO - 10.1016/j.cardfail.2024.04.017

M3 - Journal article

C2 - 38750689

AN - SCOPUS:85193975483

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

SN - 1071-9164

ER -