Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients with NonIschemic Systolic Heart Failure

Marie Bayer Elming, Jens C Nielsen, Jens Haarbo, Lars Videbæk, Eva Korup, James Signorovitch, Line Lisbeth Olesen, Per Hildebrandt, Flemming H Steffensen, Niels E Bruun, Hans Eiskjær, Axel Brandes, Anna M Thøgersen, Finn Gustafsson, Kenneth Egstrup, Regitze Videbæk, Christian Hassager, Jesper Hastrup Svendsen, Dan E Høfsten, Christian Torp-PedersenSteen Pehrson, Lars Køber, Jens Jakob Thune

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: The DANISH study (Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter Defibrillators] in Patients With Non-Ischemic Systolic Heart Failure on Mortality) did not demonstrate an overall effect on all-cause mortality with ICD implantation. However, the prespecified subgroup analysis suggested a possible age-dependent association between ICD implantation and mortality with survival benefit seen only in the youngest patients. The nature of this relationship between age and outcome of a primary prevention ICD in patients with nonischemic systolic heart failure warrants further investigation. METHODS: All 1116 patients from the DANISH study were included in this prespecified subgroup analysis. We assessed the relationship between ICD implantation and mortality by age, and an optimal age cutoff was estimated nonparametrically with selection impact curves. Modes of death were divided into sudden cardiac death and nonsudden death and compared between patients younger and older than this age cutoff with the use of χ 2 analysis. RESULTS: Median age of the study population was 63 years (range, 21-84 years). There was a linearly decreasing relationship between ICD and mortality with age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.003-1.06; P=0.03). An optimal age cutoff for ICD implantation was present at ≤70 years. There was an association between reduced all-cause mortality and ICD in patients ≤70 years of age (HR, 0.70; 95% CI, 0.51-0.96; P=0.03) but not in patients >70 years of age (HR, 1.05; 95% CI, 0.68-1.62; P=0.84). For patients ≤70 years old, the sudden cardiac death rate was 1.8 (95% CI, 1.3-2.5) and nonsudden death rate was 2.7 (95% CI, 2.1-3.5) events per 100 patient-years, whereas for patients >70 years old, the sudden cardiac death rate was 1.6 (95% CI, 0.8-3.2) and nonsudden death rate was 5.4 (95% CI, 3.7-7.8) events per 100 patient-years. This difference in modes of death between the 2 age groups was statistically significant (P=0.01). CONCLUSIONS: In patients with systolic heart failure not caused by ischemic heart disease, the association between the ICD and survival decreased linearly with increasing age. In this study population, an age cutoff for ICD implantation at ≤70 years yielded the highest survival for the population as a whole.

Original languageEnglish
JournalCirculation
Volume136
Issue number19
Pages (from-to)1772-1780
ISSN0009-7322
DOIs
Publication statusPublished - 7. Nov 2017

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Systolic Heart Failure
Implantable Defibrillators
Primary Prevention
Confidence Intervals
Population

Keywords

  • Journal Article
  • Heart failure
  • Defibrillators
  • Aging
  • Death
  • Systolic
  • Implantable
  • Multivariate Analysis
  • Age Factors
  • Humans
  • Middle Aged
  • Primary Prevention/instrumentation
  • Male
  • Death, Sudden, Cardiac/etiology
  • Heart Failure, Systolic/diagnosis
  • Young Adult
  • Time Factors
  • Defibrillators, Implantable
  • Aged, 80 and over
  • Adult
  • Female
  • Risk Factors
  • Kaplan-Meier Estimate
  • Proportional Hazards Models
  • Linear Models
  • Treatment Outcome
  • Electric Countershock/adverse effects
  • Chi-Square Distribution
  • Denmark
  • Aged

Cite this

Elming, M. B., Nielsen, J. C., Haarbo, J., Videbæk, L., Korup, E., Signorovitch, J., ... Thune, J. J. (2017). Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients with NonIschemic Systolic Heart Failure. Circulation, 136(19), 1772-1780. https://doi.org/10.1161/CIRCULATIONAHA.117.028829
Elming, Marie Bayer ; Nielsen, Jens C ; Haarbo, Jens ; Videbæk, Lars ; Korup, Eva ; Signorovitch, James ; Olesen, Line Lisbeth ; Hildebrandt, Per ; Steffensen, Flemming H ; Bruun, Niels E ; Eiskjær, Hans ; Brandes, Axel ; Thøgersen, Anna M ; Gustafsson, Finn ; Egstrup, Kenneth ; Videbæk, Regitze ; Hassager, Christian ; Svendsen, Jesper Hastrup ; Høfsten, Dan E ; Torp-Pedersen, Christian ; Pehrson, Steen ; Køber, Lars ; Thune, Jens Jakob. / Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients with NonIschemic Systolic Heart Failure. In: Circulation. 2017 ; Vol. 136, No. 19. pp. 1772-1780.
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abstract = "BACKGROUND: The DANISH study (Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter Defibrillators] in Patients With Non-Ischemic Systolic Heart Failure on Mortality) did not demonstrate an overall effect on all-cause mortality with ICD implantation. However, the prespecified subgroup analysis suggested a possible age-dependent association between ICD implantation and mortality with survival benefit seen only in the youngest patients. The nature of this relationship between age and outcome of a primary prevention ICD in patients with nonischemic systolic heart failure warrants further investigation. METHODS: All 1116 patients from the DANISH study were included in this prespecified subgroup analysis. We assessed the relationship between ICD implantation and mortality by age, and an optimal age cutoff was estimated nonparametrically with selection impact curves. Modes of death were divided into sudden cardiac death and nonsudden death and compared between patients younger and older than this age cutoff with the use of χ 2 analysis. RESULTS: Median age of the study population was 63 years (range, 21-84 years). There was a linearly decreasing relationship between ICD and mortality with age (hazard ratio [HR], 1.03; 95{\%} confidence interval [CI], 1.003-1.06; P=0.03). An optimal age cutoff for ICD implantation was present at ≤70 years. There was an association between reduced all-cause mortality and ICD in patients ≤70 years of age (HR, 0.70; 95{\%} CI, 0.51-0.96; P=0.03) but not in patients >70 years of age (HR, 1.05; 95{\%} CI, 0.68-1.62; P=0.84). For patients ≤70 years old, the sudden cardiac death rate was 1.8 (95{\%} CI, 1.3-2.5) and nonsudden death rate was 2.7 (95{\%} CI, 2.1-3.5) events per 100 patient-years, whereas for patients >70 years old, the sudden cardiac death rate was 1.6 (95{\%} CI, 0.8-3.2) and nonsudden death rate was 5.4 (95{\%} CI, 3.7-7.8) events per 100 patient-years. This difference in modes of death between the 2 age groups was statistically significant (P=0.01). CONCLUSIONS: In patients with systolic heart failure not caused by ischemic heart disease, the association between the ICD and survival decreased linearly with increasing age. In this study population, an age cutoff for ICD implantation at ≤70 years yielded the highest survival for the population as a whole.",
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author = "Elming, {Marie Bayer} and Nielsen, {Jens C} and Jens Haarbo and Lars Videb{\ae}k and Eva Korup and James Signorovitch and Olesen, {Line Lisbeth} and Per Hildebrandt and Steffensen, {Flemming H} and Bruun, {Niels E} and Hans Eiskj{\ae}r and Axel Brandes and Th{\o}gersen, {Anna M} and Finn Gustafsson and Kenneth Egstrup and Regitze Videb{\ae}k and Christian Hassager and Svendsen, {Jesper Hastrup} and H{\o}fsten, {Dan E} and Christian Torp-Pedersen and Steen Pehrson and Lars K{\o}ber and Thune, {Jens Jakob}",
year = "2017",
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Elming, MB, Nielsen, JC, Haarbo, J, Videbæk, L, Korup, E, Signorovitch, J, Olesen, LL, Hildebrandt, P, Steffensen, FH, Bruun, NE, Eiskjær, H, Brandes, A, Thøgersen, AM, Gustafsson, F, Egstrup, K, Videbæk, R, Hassager, C, Svendsen, JH, Høfsten, DE, Torp-Pedersen, C, Pehrson, S, Køber, L & Thune, JJ 2017, 'Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients with NonIschemic Systolic Heart Failure', Circulation, vol. 136, no. 19, pp. 1772-1780. https://doi.org/10.1161/CIRCULATIONAHA.117.028829

Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients with NonIschemic Systolic Heart Failure. / Elming, Marie Bayer; Nielsen, Jens C; Haarbo, Jens; Videbæk, Lars; Korup, Eva; Signorovitch, James; Olesen, Line Lisbeth; Hildebrandt, Per; Steffensen, Flemming H; Bruun, Niels E; Eiskjær, Hans; Brandes, Axel; Thøgersen, Anna M; Gustafsson, Finn; Egstrup, Kenneth; Videbæk, Regitze; Hassager, Christian; Svendsen, Jesper Hastrup; Høfsten, Dan E; Torp-Pedersen, Christian; Pehrson, Steen; Køber, Lars; Thune, Jens Jakob.

In: Circulation, Vol. 136, No. 19, 07.11.2017, p. 1772-1780.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients with NonIschemic Systolic Heart Failure

AU - Elming, Marie Bayer

AU - Nielsen, Jens C

AU - Haarbo, Jens

AU - Videbæk, Lars

AU - Korup, Eva

AU - Signorovitch, James

AU - Olesen, Line Lisbeth

AU - Hildebrandt, Per

AU - Steffensen, Flemming H

AU - Bruun, Niels E

AU - Eiskjær, Hans

AU - Brandes, Axel

AU - Thøgersen, Anna M

AU - Gustafsson, Finn

AU - Egstrup, Kenneth

AU - Videbæk, Regitze

AU - Hassager, Christian

AU - Svendsen, Jesper Hastrup

AU - Høfsten, Dan E

AU - Torp-Pedersen, Christian

AU - Pehrson, Steen

AU - Køber, Lars

AU - Thune, Jens Jakob

PY - 2017/11/7

Y1 - 2017/11/7

N2 - BACKGROUND: The DANISH study (Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter Defibrillators] in Patients With Non-Ischemic Systolic Heart Failure on Mortality) did not demonstrate an overall effect on all-cause mortality with ICD implantation. However, the prespecified subgroup analysis suggested a possible age-dependent association between ICD implantation and mortality with survival benefit seen only in the youngest patients. The nature of this relationship between age and outcome of a primary prevention ICD in patients with nonischemic systolic heart failure warrants further investigation. METHODS: All 1116 patients from the DANISH study were included in this prespecified subgroup analysis. We assessed the relationship between ICD implantation and mortality by age, and an optimal age cutoff was estimated nonparametrically with selection impact curves. Modes of death were divided into sudden cardiac death and nonsudden death and compared between patients younger and older than this age cutoff with the use of χ 2 analysis. RESULTS: Median age of the study population was 63 years (range, 21-84 years). There was a linearly decreasing relationship between ICD and mortality with age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.003-1.06; P=0.03). An optimal age cutoff for ICD implantation was present at ≤70 years. There was an association between reduced all-cause mortality and ICD in patients ≤70 years of age (HR, 0.70; 95% CI, 0.51-0.96; P=0.03) but not in patients >70 years of age (HR, 1.05; 95% CI, 0.68-1.62; P=0.84). For patients ≤70 years old, the sudden cardiac death rate was 1.8 (95% CI, 1.3-2.5) and nonsudden death rate was 2.7 (95% CI, 2.1-3.5) events per 100 patient-years, whereas for patients >70 years old, the sudden cardiac death rate was 1.6 (95% CI, 0.8-3.2) and nonsudden death rate was 5.4 (95% CI, 3.7-7.8) events per 100 patient-years. This difference in modes of death between the 2 age groups was statistically significant (P=0.01). CONCLUSIONS: In patients with systolic heart failure not caused by ischemic heart disease, the association between the ICD and survival decreased linearly with increasing age. In this study population, an age cutoff for ICD implantation at ≤70 years yielded the highest survival for the population as a whole.

AB - BACKGROUND: The DANISH study (Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter Defibrillators] in Patients With Non-Ischemic Systolic Heart Failure on Mortality) did not demonstrate an overall effect on all-cause mortality with ICD implantation. However, the prespecified subgroup analysis suggested a possible age-dependent association between ICD implantation and mortality with survival benefit seen only in the youngest patients. The nature of this relationship between age and outcome of a primary prevention ICD in patients with nonischemic systolic heart failure warrants further investigation. METHODS: All 1116 patients from the DANISH study were included in this prespecified subgroup analysis. We assessed the relationship between ICD implantation and mortality by age, and an optimal age cutoff was estimated nonparametrically with selection impact curves. Modes of death were divided into sudden cardiac death and nonsudden death and compared between patients younger and older than this age cutoff with the use of χ 2 analysis. RESULTS: Median age of the study population was 63 years (range, 21-84 years). There was a linearly decreasing relationship between ICD and mortality with age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.003-1.06; P=0.03). An optimal age cutoff for ICD implantation was present at ≤70 years. There was an association between reduced all-cause mortality and ICD in patients ≤70 years of age (HR, 0.70; 95% CI, 0.51-0.96; P=0.03) but not in patients >70 years of age (HR, 1.05; 95% CI, 0.68-1.62; P=0.84). For patients ≤70 years old, the sudden cardiac death rate was 1.8 (95% CI, 1.3-2.5) and nonsudden death rate was 2.7 (95% CI, 2.1-3.5) events per 100 patient-years, whereas for patients >70 years old, the sudden cardiac death rate was 1.6 (95% CI, 0.8-3.2) and nonsudden death rate was 5.4 (95% CI, 3.7-7.8) events per 100 patient-years. This difference in modes of death between the 2 age groups was statistically significant (P=0.01). CONCLUSIONS: In patients with systolic heart failure not caused by ischemic heart disease, the association between the ICD and survival decreased linearly with increasing age. In this study population, an age cutoff for ICD implantation at ≤70 years yielded the highest survival for the population as a whole.

KW - Journal Article

KW - Heart failure

KW - Defibrillators

KW - Aging

KW - Death

KW - Systolic

KW - Implantable

KW - Multivariate Analysis

KW - Age Factors

KW - Humans

KW - Middle Aged

KW - Primary Prevention/instrumentation

KW - Male

KW - Death, Sudden, Cardiac/etiology

KW - Heart Failure, Systolic/diagnosis

KW - Young Adult

KW - Time Factors

KW - Defibrillators, Implantable

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Risk Factors

KW - Kaplan-Meier Estimate

KW - Proportional Hazards Models

KW - Linear Models

KW - Treatment Outcome

KW - Electric Countershock/adverse effects

KW - Chi-Square Distribution

KW - Denmark

KW - Aged

U2 - 10.1161/CIRCULATIONAHA.117.028829

DO - 10.1161/CIRCULATIONAHA.117.028829

M3 - Journal article

C2 - 28877914

VL - 136

SP - 1772

EP - 1780

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 19

ER -