Primary prevention implantable cardioverter defibrillators in patients with nonischemic cardiomyopathy: A meta-analysis

Sana M. Al-Khatib, Gregg C. Fonarow, Jose A. Joglar, Lurdes Y.T. Inoue, Daniel B. Mark, Kerry L. Lee, Alan Kadish, Gust Bardy, Gillian D. Sanders

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43 Scopus citations

Abstract

Importance: Conflicting data have emerged on the efficacy of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death (primary prevention ICDs) in patients with nonischemic cardiomyopathy. Objective: To investigate the association of primary prevention ICDs with all-cause mortality in patients with nonischemic cardiomyopathy. Data Sources: PubMed was searched from January 1, 2000, through October 31, 2016, for the terms implantable defibrillator OR implantable cardioverter defibrillator AND non-ischemic cardiomyopathy. Additional references were identified from bibliographies of pertinent articles and queries to experts in this field. Study Selection: Inclusion criteria consisted of a randomized clinical trial design and comparison of the ICD with medical therapy (control) in at least 100 patients with nonischemic cardiomyopathy. In addition, studies had to report on all-cause mortality during a follow-up period of at least 12 months and be published in English. The search yielded 10 studies, of which only 1met the inclusion criteria. A search of bibliographies of pertinent articles and queries of experts in this field led to 3 additional studies. Data Extraction and Synthesis: The PRISMA guidelines were used to abstract data and assess data quality and validity. Data were pooled using fixed- and random-effects models. Main Outcomes and Measures: The primary end pointwas all-cause mortality. Before data collection started, primary prevention ICDs were hypothesized to reduce all-cause mortality among patients with nonischemic cardiomyopathy. Results: Four randomized clinical trials met the selection criteria and included 1874 unique patients; 937 were in the ICD group and 937 in the control group. Pooling data from these trials showed a significant reduction in all-cause mortality with an ICD (hazard ratio, 0.75; 95% CI, 0.61-0.93; P = .008; P = .87 for heterogeneity). Conclusions and Relevance: Primary prevention ICDs are efficacious at reducing all-cause mortality among patients with nonischemic cardiomyopathy. These findings support professional guidelines that recommend the use of ICDs in such patients.

Original languageEnglish (US)
Pages (from-to)685-688
Number of pages4
JournalJAMA Cardiology
Volume2
Issue number6
DOIs
StatePublished - Jun 1 2017

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Al-Khatib, S. M., Fonarow, G. C., Joglar, J. A., Inoue, L. Y. T., Mark, D. B., Lee, K. L., Kadish, A., Bardy, G., & Sanders, G. D. (2017). Primary prevention implantable cardioverter defibrillators in patients with nonischemic cardiomyopathy: A meta-analysis. JAMA Cardiology, 2(6), 685-688. https://doi.org/10.1001/jamacardio.2017.0630