Patients with improved left ventricular ejection fraction without implantable cardioverter defibrillator may continue to be at high mortality risk despite optimal medical management

Authors

Kanwar Yugraj Singh
Firas Zahwe, Advocate Aurora HealthFollow
Tadele W. Mengesha, Advocate Aurora HealthFollow
Robyn Shearer, Advocate Aurora HealthFollow
Crystal Platz, Advocate Aurora HealthFollow
Bilal Omery, Advocate Aurora HealthFollow
Arshad Jahangir, Advocate Aurora HealthFollow
Wassim Ballany, Advocate Aurora HealthFollow
Masood Akhtar, Advocate Aurora HealthFollow
M. Eyman Mortada, Advocate Aurora HealthFollow
Jasbir Sra, Advocate Aurora HealthFollow
Indrajit Choudhuri, Advocate Aurora HealthFollow

Recommended Citation

Singh KY, Zahwe F, Mengesha T, et al. Patients with improved left ventricular ejection fraction without implantable cardioverter defibrillator may continue to be at high mortality risk despite optimal medical management. Poster presented at: Heart Rhythm Scientific Sessions; May 12, 2017; Chicago, IL.

Affiliations

Aurora Cardiovascular Services

Aurora Sinai/Aurora St. Luke's Medical Centers

Aurora Research Institute

Center for Integrative Research on CV Aging - Aurora Health Care

Presentation Notes

Poster presented at: Heart Rhythm Scientific Sessions; May 12, 2017; Chicago, IL.

Abstract

BACKGROUND: With advances in medical and interventional management, the risk of sudden cardiac death (SCD) has decreased in the high-risk patients identified by left ventricular ejection fraction (LVEF)

OBJECTIVE: To evaluate benefit of ICD in addition to optimal medical management (OMT) in patients with improved LVEF.

METHODS: Aurora Healthcare patient records from 1/2010 to 10/2014 were screened to identify patients with LVEF≤35% and subsequent improvement to EF≥40%, in whom ICD implant was deferred vs. patients who received ICD. Propensity score matching was applied to match the medications and other clinical confounders. The primary outcome was all-cause mortality.

RESULTS: One thousand three hundred sixty-four patients were identified with improved LVEF during the study period. We further propensity matched both groups for clinical characteristics and medications at improved LVEF (40-49%) to evaluate additional benefit of ICD in this cohort of patients. A total of 540 patients were included in the mortality analysis. Sixty-eight patients (15%) in non-ICD group died (majority as SCD) as compared to 10 (9%) in the ICD group (majority non-SCD), p=0.0108 . This effect was not statistically significant in patients with completely recovered LVEF >50%.

CONCLUSIONS: Our findings suggest that the ICD may continue to provide survival benefit over and above OMT in patients with improved LVEF.

Document Type

Poster