肥厚型心肌病患者植入式心律转复除颤器的使用情况及预后的全球和时间趋势
Global and Temporal Trends in Utilization and Outcomes of Implantable Cardioverter Defibrillators in Hypertrophic Cardiomyopathy.
作者信息
Abdelfattah Omar M, Sayed Ahmed, Al-Jwaid Ahmed, Hassan Ahmed, Abu Jazar Deaa, Narayanan Arun, Link Mark S, Martinez Matthew W
机构信息
Hypertrophic Cardiomyopathy Center, Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (O.M.A., D.A.J., A.N.).
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, TX (A.S.).
出版信息
Circ Arrhythm Electrophysiol. 2025 Feb;18(2):e013479. doi: 10.1161/CIRCEP.124.013479. Epub 2025 Feb 3.
BACKGROUND
Over the past decades, hypertrophic cardiomyopathy has become a contemporary treatable disease. However, limited data exist on the global trends of implantable cardioverter defibrillator (ICD) utilization and its impact on mortality/morbidity burden reduction.
METHODS
Electronic databases were systematically searched up to March 2024 for studies reporting on ICD utilization rates in hypertrophic cardiomyopathy. A random effects model was used to pool study estimates across time-era, geographic region, and age group. Primary outcome was global trends in ICD utilization. Secondary outcomes included trends of sudden cardiac death, appropriate/inappropriate shocks, and ICD-related complications.
RESULTS
In total, 234 studies (N=92 500, 514 748 patient-years) met inclusion criteria. Mean age was 46.2 (12.4) years and 37.49% were women. A total of 12 139 patients (16.43%) received an ICD over 429 766 person-years of follow-up, with an ICD implantation rate of 2.79%/y ([95% CI, 2.35%-3.32%] I²=97.80%). Rates of ICD implantation steadily increased over time from 1990 (1.09%) to 2021 (4.01%; =0.002), with noticeable geographic variation (=0.008). The overall rate of appropriate ICD discharges and ICD-related complications was 3.44%/y ([95% CI, 3.08%-3.84%] I²=88.40%) and 1.98%/y ([95% CI, 1.52%-2.59%] I²=90.44%), respectively, with no significant trend over time. The overall rate of inappropriate discharges was 3.58%/y ([95% CI, 3.08%-4.16%] I=88.03%), and declined significantly over time (=0.044). There was a significant decline in the rates of sudden cardiac death from 1990 (0.84%/y) to 2020 (0.31%/y).
CONCLUSIONS
Dramatic increases in ICD utilization have occurred, representing a 3.7-fold increase, with appropriate therapies occurring in 3.44%/y. In parallel a significant reduction in sudden cardiac death was observed, but there are insufficient data to demonstrate that a causative relationship exists. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy.
REGISTRATION
URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023407126.
背景
在过去几十年中，肥厚型心肌病已成为一种现代可治疗疾病。然而，关于植入式心脏复律除颤器（ICD）使用的全球趋势及其对降低死亡率/发病率负担的影响的数据有限。
方法
系统检索电子数据库至2024年3月，以查找报告肥厚型心肌病中ICD使用率的研究。采用随机效应模型汇总不同时间阶段、地理区域和年龄组的研究估计值。主要结局是ICD使用的全球趋势。次要结局包括心源性猝死、恰当/不恰当电击以及与ICD相关并发症的趋势。
结果
共有234项研究（N = 92500，514748患者年）符合纳入标准。平均年龄为46.2（12.4）岁，女性占37.49%。在429766人年的随访中，共有12139例患者（16.43%）接受了ICD植入，ICD植入率为2.79%/年（[95%CI，2.35% - 3.32%]，I² = 97.80%）。从1990年（1.09%）到2021年（4.01%；P = 0.002），ICD植入率随时间稳步上升，且存在明显的地理差异（P = 0.008）。恰当ICD放电和与ICD相关并发症的总体发生率分别为3.44%/年（[95%CI，3.08% - 3.84%]，I² = 88.40%）和1.98%/年（[95%CI，1.52% - 2.59%]，I² = 90.44%），随时间无显著趋势。不恰当放电的总体发生率为3.58%/年（[95%CI，3.08% - 4.16%]，I = 88.03%），且随时间显著下降（P = 0.044）。从1990年（0.84%/年）到2020年（0.3/%/年），心源性猝死发生率显著下降。
结论
ICD使用显著增加，增长了3.7倍，恰当治疗发生率为3.44%/年。与此同时，观察到心源性猝死显著减少，但尚无足够数据证明存在因果关系。ICD使用存在地理差异，这凸显了改善肥厚型心肌病患者获得专科护理机会的必要性。ICD使用存在地理差异，这凸显了改善肥厚型心肌病患者获得专科护理机会的必要性。
注册
网址：https://www.crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42023407126。
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