Duke Clinical Research Institute Duke University School of Medicine Durham NC.
McGill University Health Centre Montreal Quebec Canada.
J Am Heart Assoc. 2020 Jun 16;9(12):e012405. doi: 10.1161/JAHA.119.012405. Epub 2020 May 30.
Background There are conflicting data regarding the benefit of primary prevention implantable cardioverter-defibrillators (ICDs) in patients with diabetes mellitus and heart failure (HF) with reduced ejection fraction. We aimed to assess the comparative effectiveness of ICD placement in patients with diabetes mellitus and HF with reduced ejection fraction. Methods and Results Data were obtained from the Get With the Guidelines-Health Failure registry, linked with claims from the Centers for Medicare & Medicaid Services. We used a Cox proportional hazards model censored at 5 years with propensity score matching. Of the 17 186 patients with HF with reduced ejection fraction from the Centers for Medicare & Medicaid Services claims database (6540 with diabetes mellitus; 38%), 1677 (646 with diabetes mellitus; 39%) received an ICD during their index HF hospitalization or were prescribed an ICD at discharge. Patients with diabetes mellitus and an ICD (n=646), as compared with those without an ICD (n=1031), were more likely to be younger (74 versus 78 years of age) and have coronary artery disease (68% versus 60%). After propensity matching, ICD use among patients with diabetes mellitus, as compared with those without an ICD, was associated with a reduced risk of all-cause mortality at 5 years after HF discharge (54% versus 59%; multivariable hazard ratio, 0.73; 95% CI, 0.64-0.82; <0.0001). Ischemic heart disease did not modify the association between ICD use and all-cause mortality (=0.95 for interaction). Similar results were seen in patients without diabetes mellitus. Conclusions Primary prevention ICD use among older patients with HF with reduced ejection fraction and diabetes mellitus was associated with a reduced risk of all-cause mortality. Our analysis supports current guideline recommendations for implantation of primary prevention ICDs among older patients with diabetes mellitus and HF with reduced ejection fraction.
关于有射血分数降低的心力衰竭（HF）合并糖尿病的患者，进行一级预防植入式心脏转复除颤器（ICD）的获益存在争议数据。我们旨在评估在有射血分数降低的 HF 合并糖尿病的患者中，ICD 植入的比较效果。
数据来自于“遵循指南-心力衰竭（Get With The Guidelines-Health Failure）”注册研究，并与医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）的理赔数据相关联。我们使用了在 5 年时进行删失的 Cox 比例风险模型和倾向评分匹配。医疗保险和医疗补助服务中心理赔数据库中 17186 例射血分数降低的 HF 患者（38%合并糖尿病）中，有 1677 例（646 例合并糖尿病；39%）在其 HF 住院期间植入了 ICD，或在出院时被处方了 ICD。与未植入 ICD 的患者（n=1031）相比，植入 ICD 的糖尿病患者（n=646）更年轻（74 岁比 78 岁）且更可能合并冠状动脉疾病（68%比 60%）。在倾向评分匹配后，与未植入 ICD 的患者相比，糖尿病患者植入 ICD 与 HF 出院后 5 年全因死亡率降低相关（54%比 59%；多变量危险比，0.73；95%CI，0.64-0.82；<0.0001）。ICD 使用与全因死亡率之间的关联未因缺血性心脏病而改变（交互作用的 P 值=0.95）。在无糖尿病的患者中也观察到了类似的结果。
在射血分数降低的 HF 合并糖尿病的老年患者中，一级预防 ICD 的使用与全因死亡率降低相关。我们的分析支持当前指南推荐在射血分数降低的 HF 合并糖尿病的老年患者中植入一级预防 ICD。
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