Equivalent arrhythmic risk in patients recently diagnosed with dilated cardiomyopathy compared with patients diagnosed for 9 months or more

Kevin J. Makati, Airley E. Fish, Hannah H. England, Hocine Tighiouart, N. A.Mark Estes, Mark S. Link

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: The Centers for Medicare and Medicaid Services (CMS) recently expanded coverage for implantable cardioverter-defibrillators (ICDs) in patients with left ventricular ejection fraction ≤35% and nonischemic dilated cardiomyopathy for ≥9 months. To investigate the ramifications of these criteria, the ICD registry from Tufts-New England Medical Center was analyzed for arrhythmic events and death in patients with newly diagnosed (<9 months) vs late-diagnosed (≥9 months) nonischemic dilated cardiomyopathy. Objectives: The purpose of this study was to analyze the arrhythmic risk in patients with recent vs late diagnosis of nonischemic dilated cardiomyopathy. Methods: One hundred thirty-one patients with nonischemic dilated cardiomyopathy were divided into two cohorts (<9 or ≥9 months of symptoms) and analyzed for any occurrence of treated ventricular arrhythmia, potentially lethal arrhythmias defined as ventricular flutter rates ≥230 bpm, and ventricular fibrillation. Patients with documented sustained ventricular tachycardias (included in prior CMS coverage) were excluded. Results: In the study group, the mean age was 58.1 ± 15 years and ejection fraction 20.6% ± 8%. In a follow-up period of 25.3 ± 24 months, the 52 patients with a recent diagnosis (1.4 ± 2 months) had no difference in the occurrence of ventricular arrhythmias (P = .49) and malignant ventricular arrhythmias (P = .16) compared with the 79 patients diagnosed ≥9 months (mean 58.1 ± 39 months). Conclusion: Patients with nonischemic dilated cardiomyopathy experienced equivalent occurrences of treated and potentially lethal arrhythmias irrespective of diagnosis duration. These findings suggest that the 9-month time qualifier used in the CMS guidelines for ICD reimbursement may not reliably discriminate patients at high risk for sudden cardiac death in this selected population.

Original languageEnglish (US)
Pages (from-to)397-403
Number of pages7
JournalHeart Rhythm
Volume3
Issue number4
DOIs
StatePublished - Apr 1 2006

Fingerprint

Dilated Cardiomyopathy
Cardiac Arrhythmias
Centers for Medicare and Medicaid Services (U.S.)
Implantable Defibrillators
Ventricular Flutter
New England
Delayed Diagnosis
Sudden Cardiac Death
Ventricular Fibrillation
Ventricular Tachycardia
Stroke Volume
Registries
Age Groups
Guidelines

Keywords

  • Heart failure
  • Idiopathic dilated cardiomyopathy
  • Implantable cardioverter-defibrillator
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Equivalent arrhythmic risk in patients recently diagnosed with dilated cardiomyopathy compared with patients diagnosed for 9 months or more. / Makati, Kevin J.; Fish, Airley E.; England, Hannah H.; Tighiouart, Hocine; Estes, N. A.Mark; Link, Mark S.

In: Heart Rhythm, Vol. 3, No. 4, 01.04.2006, p. 397-403.

Research output: Contribution to journalArticle

Makati, Kevin J. ; Fish, Airley E. ; England, Hannah H. ; Tighiouart, Hocine ; Estes, N. A.Mark ; Link, Mark S. / Equivalent arrhythmic risk in patients recently diagnosed with dilated cardiomyopathy compared with patients diagnosed for 9 months or more. In: Heart Rhythm. 2006 ; Vol. 3, No. 4. pp. 397-403.
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AB - Background: The Centers for Medicare and Medicaid Services (CMS) recently expanded coverage for implantable cardioverter-defibrillators (ICDs) in patients with left ventricular ejection fraction ≤35% and nonischemic dilated cardiomyopathy for ≥9 months. To investigate the ramifications of these criteria, the ICD registry from Tufts-New England Medical Center was analyzed for arrhythmic events and death in patients with newly diagnosed (<9 months) vs late-diagnosed (≥9 months) nonischemic dilated cardiomyopathy. Objectives: The purpose of this study was to analyze the arrhythmic risk in patients with recent vs late diagnosis of nonischemic dilated cardiomyopathy. Methods: One hundred thirty-one patients with nonischemic dilated cardiomyopathy were divided into two cohorts (<9 or ≥9 months of symptoms) and analyzed for any occurrence of treated ventricular arrhythmia, potentially lethal arrhythmias defined as ventricular flutter rates ≥230 bpm, and ventricular fibrillation. Patients with documented sustained ventricular tachycardias (included in prior CMS coverage) were excluded. Results: In the study group, the mean age was 58.1 ± 15 years and ejection fraction 20.6% ± 8%. In a follow-up period of 25.3 ± 24 months, the 52 patients with a recent diagnosis (1.4 ± 2 months) had no difference in the occurrence of ventricular arrhythmias (P = .49) and malignant ventricular arrhythmias (P = .16) compared with the 79 patients diagnosed ≥9 months (mean 58.1 ± 39 months). Conclusion: Patients with nonischemic dilated cardiomyopathy experienced equivalent occurrences of treated and potentially lethal arrhythmias irrespective of diagnosis duration. These findings suggest that the 9-month time qualifier used in the CMS guidelines for ICD reimbursement may not reliably discriminate patients at high risk for sudden cardiac death in this selected population.

KW - Heart failure

KW - Idiopathic dilated cardiomyopathy

KW - Implantable cardioverter-defibrillator

KW - Sudden cardiac death

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