Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10362/104066 |
Resumo: | BACKGROUND Medical therapy for heart failure with reduced ejection fraction evolved since trials validated the use of implantable cardioverter-defibrillators (ICDs). We sought to evaluate the performance of ICDs in reducing mortality in the era of modern medical therapy by means of a systematic review and meta-analysis of contemporary randomized clinical trials of drug therapy for heart failure with reduced ejection fraction. METHODS AND RESULTS We systematically identified randomized clinical trials that evaluated drug therapy in patients with heart failure with reduced ejection fraction that reported mortality. Studies that enrolled <1000 patients, patients with left ventricular ejection fraction >40%, or patients in the acute phase of heart failure and study treatment with devices were excluded. We identified 8 randomized clinical trials, including 31 701 patients of whom 3631 (11.5%) had an ICD. ICDs were associated with a lower risk of all-cause mortality (relative risk [RR], 0.85; 95% CI, 0.78-0.94) and sudden cardiac death (RR, 0.49; 95% CI, 0.40-0.61). Results were consistent among studies published before and after 2010. In meta-regression analysis, the proportion of nonischemic etiology did not affect the associated benefit of ICD. CONCLUSIONS In our meta-analysis of contemporary randomized trials of drug therapy for heart failure with reduced ejection fraction, the rate of ICD use was low and associated with a decreased risk in both all-cause mortality and sudden cardiac death. This benefit was still present in trials with new medical therapy. |
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Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart FailureA Systematic Review and Meta-Analysisall‐cause mortalityheart failure with reduced ejection fractionimplantable cardioverter–defibrillatorssudden cardiac deathCardiology and Cardiovascular MedicineBACKGROUND Medical therapy for heart failure with reduced ejection fraction evolved since trials validated the use of implantable cardioverter-defibrillators (ICDs). We sought to evaluate the performance of ICDs in reducing mortality in the era of modern medical therapy by means of a systematic review and meta-analysis of contemporary randomized clinical trials of drug therapy for heart failure with reduced ejection fraction. METHODS AND RESULTS We systematically identified randomized clinical trials that evaluated drug therapy in patients with heart failure with reduced ejection fraction that reported mortality. Studies that enrolled <1000 patients, patients with left ventricular ejection fraction >40%, or patients in the acute phase of heart failure and study treatment with devices were excluded. We identified 8 randomized clinical trials, including 31 701 patients of whom 3631 (11.5%) had an ICD. ICDs were associated with a lower risk of all-cause mortality (relative risk [RR], 0.85; 95% CI, 0.78-0.94) and sudden cardiac death (RR, 0.49; 95% CI, 0.40-0.61). Results were consistent among studies published before and after 2010. In meta-regression analysis, the proportion of nonischemic etiology did not affect the associated benefit of ICD. CONCLUSIONS In our meta-analysis of contemporary randomized trials of drug therapy for heart failure with reduced ejection fraction, the rate of ICD use was low and associated with a decreased risk in both all-cause mortality and sudden cardiac death. This benefit was still present in trials with new medical therapy.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNGama, FranciscoFerreira, JorgeCarmo, JoãoCosta, Francisco MoscosoCarvalho, SaloméCarmo, PedroCavaco, DiogoMorgado, Francisco BeloAdragão, PedroMendes, Miguel2020-09-14T22:32:15Z2020-04-212020-04-21T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10362/104066eng2047-9980PURE: 18173586https://doi.org/10.1161/JAHA.119.015177info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-10T15:55:55ZPortal AgregadorONG |
dc.title.none.fl_str_mv |
Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure A Systematic Review and Meta-Analysis |
title |
Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure |
spellingShingle |
Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure Gama, Francisco all‐cause mortality heart failure with reduced ejection fraction implantable cardioverter–defibrillators sudden cardiac death Cardiology and Cardiovascular Medicine |
title_short |
Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure |
title_full |
Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure |
title_fullStr |
Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure |
title_full_unstemmed |
Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure |
title_sort |
Implantable Cardioverter-Defibrillators in Trials of Drug Therapy for Heart Failure |
author |
Gama, Francisco |
author_facet |
Gama, Francisco Ferreira, Jorge Carmo, João Costa, Francisco Moscoso Carvalho, Salomé Carmo, Pedro Cavaco, Diogo Morgado, Francisco Belo Adragão, Pedro Mendes, Miguel |
author_role |
author |
author2 |
Ferreira, Jorge Carmo, João Costa, Francisco Moscoso Carvalho, Salomé Carmo, Pedro Cavaco, Diogo Morgado, Francisco Belo Adragão, Pedro Mendes, Miguel |
author2_role |
author author author author author author author author author |
dc.contributor.none.fl_str_mv |
NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) RUN |
dc.contributor.author.fl_str_mv |
Gama, Francisco Ferreira, Jorge Carmo, João Costa, Francisco Moscoso Carvalho, Salomé Carmo, Pedro Cavaco, Diogo Morgado, Francisco Belo Adragão, Pedro Mendes, Miguel |
dc.subject.por.fl_str_mv |
all‐cause mortality heart failure with reduced ejection fraction implantable cardioverter–defibrillators sudden cardiac death Cardiology and Cardiovascular Medicine |
topic |
all‐cause mortality heart failure with reduced ejection fraction implantable cardioverter–defibrillators sudden cardiac death Cardiology and Cardiovascular Medicine |
description |
BACKGROUND Medical therapy for heart failure with reduced ejection fraction evolved since trials validated the use of implantable cardioverter-defibrillators (ICDs). We sought to evaluate the performance of ICDs in reducing mortality in the era of modern medical therapy by means of a systematic review and meta-analysis of contemporary randomized clinical trials of drug therapy for heart failure with reduced ejection fraction. METHODS AND RESULTS We systematically identified randomized clinical trials that evaluated drug therapy in patients with heart failure with reduced ejection fraction that reported mortality. Studies that enrolled <1000 patients, patients with left ventricular ejection fraction >40%, or patients in the acute phase of heart failure and study treatment with devices were excluded. We identified 8 randomized clinical trials, including 31 701 patients of whom 3631 (11.5%) had an ICD. ICDs were associated with a lower risk of all-cause mortality (relative risk [RR], 0.85; 95% CI, 0.78-0.94) and sudden cardiac death (RR, 0.49; 95% CI, 0.40-0.61). Results were consistent among studies published before and after 2010. In meta-regression analysis, the proportion of nonischemic etiology did not affect the associated benefit of ICD. CONCLUSIONS In our meta-analysis of contemporary randomized trials of drug therapy for heart failure with reduced ejection fraction, the rate of ICD use was low and associated with a decreased risk in both all-cause mortality and sudden cardiac death. This benefit was still present in trials with new medical therapy. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-09-14T22:32:15Z 2020-04-21 2020-04-21T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10362/104066 |
url |
http://hdl.handle.net/10362/104066 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
2047-9980 PURE: 18173586 https://doi.org/10.1161/JAHA.119.015177 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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