The effect of implantable cardioverter-defibrillator in patients with diabetes and non-ischaemic systolic heart failure

Rasmus Rørth*, Jens Jakob Thune, Jens C Nielsen, Jens Haarbo, Lars Videbæk, Eva Korup, James Signorovitch, Niels E Bruun, Hans Eiskjær, Christian Hassager, Jesper Hastrup Svendsen, Dan E Høfsten, Christian Torp-Pedersen, Steen Pehrson, Lars Køber, Søren L Kristensen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

AIMS: Implantable cardioverter-defibrillator (ICD) implantation reduce the risk of sudden cardiac death, but not all-cause death in patients with non-ischaemic systolic heart failure (HF). Whether co-existence of diabetes affects ICD treatment effects is unclear.

METHODS AND RESULTS: We examined the effect of ICD implantation on risk of all-cause death, cardiovascular death, and sudden cardiac death (SCD) according to diabetes status at baseline in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial. Outcomes were analysed by use of cumulative incidence curves and Cox regressions models. Of the 1116 patients enrolled, 211 (19%) had diabetes at baseline. Patients with diabetes were more obese, had worse kidney function and more were in New York Heart Association Class III/IV. The risk of device infections and other complications in the ICD group was similar among patients with and without diabetes (6.1% vs. 4.6% P = 0.54). Irrespective of treatment group, diabetes was associated with higher risk of all-cause death, cardiovascular death, and SCD. The treatment effect of ICD in patients with diabetes vs. patients without diabetes was hazard ratio (HR) = 0.92 (0.57-1.50) vs. HR = 0.85 (0.63-1.13); Pinteraction = 0.60 for all-cause mortality, HR = 0.99 (0.58-1.70) vs. HR = 0.70 (0.48-1.01); Pinteraction = 0.25 for cardiovascular death, and HR = 0.81 (0.35-1.88) vs. HR = 0.40 (0.22-0.76); Pinteraction = 0.16 for sudden cardiac death.

CONCLUSION: Among patients with non-ischaemic systolic HF, diabetes was associated with higher incidence of all-cause mortality, primarily driven by cardiovascular mortality including SCD. Treatment effect of ICD therapy was not significantly modified by diabetes which might be due to lack of power.

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Systolic Heart Failure
Implantable Defibrillators
Cause of Death
Incidence
Proportional Hazards Models
Kidney
Equipment and Supplies

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Rørth, Rasmus ; Thune, Jens Jakob ; Nielsen, Jens C ; Haarbo, Jens ; Videbæk, Lars ; Korup, Eva ; Signorovitch, James ; Bruun, Niels E ; Eiskjær, Hans ; Hassager, Christian ; Svendsen, Jesper Hastrup ; Høfsten, Dan E ; Torp-Pedersen, Christian ; Pehrson, Steen ; Køber, Lars ; Kristensen, Søren L. / The effect of implantable cardioverter-defibrillator in patients with diabetes and non-ischaemic systolic heart failure. In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2019 ; Vol. 21, No. 8. pp. 1203-1210.
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title = "The effect of implantable cardioverter-defibrillator in patients with diabetes and non-ischaemic systolic heart failure",
abstract = "AIMS: Implantable cardioverter-defibrillator (ICD) implantation reduce the risk of sudden cardiac death, but not all-cause death in patients with non-ischaemic systolic heart failure (HF). Whether co-existence of diabetes affects ICD treatment effects is unclear.METHODS AND RESULTS: We examined the effect of ICD implantation on risk of all-cause death, cardiovascular death, and sudden cardiac death (SCD) according to diabetes status at baseline in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial. Outcomes were analysed by use of cumulative incidence curves and Cox regressions models. Of the 1116 patients enrolled, 211 (19{\%}) had diabetes at baseline. Patients with diabetes were more obese, had worse kidney function and more were in New York Heart Association Class III/IV. The risk of device infections and other complications in the ICD group was similar among patients with and without diabetes (6.1{\%} vs. 4.6{\%} P = 0.54). Irrespective of treatment group, diabetes was associated with higher risk of all-cause death, cardiovascular death, and SCD. The treatment effect of ICD in patients with diabetes vs. patients without diabetes was hazard ratio (HR) = 0.92 (0.57-1.50) vs. HR = 0.85 (0.63-1.13); Pinteraction = 0.60 for all-cause mortality, HR = 0.99 (0.58-1.70) vs. HR = 0.70 (0.48-1.01); Pinteraction = 0.25 for cardiovascular death, and HR = 0.81 (0.35-1.88) vs. HR = 0.40 (0.22-0.76); Pinteraction = 0.16 for sudden cardiac death.CONCLUSION: Among patients with non-ischaemic systolic HF, diabetes was associated with higher incidence of all-cause mortality, primarily driven by cardiovascular mortality including SCD. Treatment effect of ICD therapy was not significantly modified by diabetes which might be due to lack of power.",
author = "Rasmus R{\o}rth and Thune, {Jens Jakob} and Nielsen, {Jens C} and Jens Haarbo and Lars Videb{\ae}k and Eva Korup and James Signorovitch and Bruun, {Niels E} and Hans Eiskj{\ae}r 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 Kristensen, {S{\o}ren L}",
note = "Published on behalf of the European Society of Cardiology. All rights reserved. {\circledC} The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.",
year = "2019",
month = "8",
day = "1",
doi = "10.1093/europace/euz114",
language = "English",
volume = "21",
pages = "1203--1210",
journal = "Europace",
issn = "1099-5129",
publisher = "Heinemann",
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The effect of implantable cardioverter-defibrillator in patients with diabetes and non-ischaemic systolic heart failure. / Rørth, Rasmus; Thune, Jens Jakob; Nielsen, Jens C; Haarbo, Jens; Videbæk, Lars; Korup, Eva; Signorovitch, James; Bruun, Niels E; Eiskjær, Hans; Hassager, Christian; Svendsen, Jesper Hastrup; Høfsten, Dan E; Torp-Pedersen, Christian; Pehrson, Steen; Køber, Lars; Kristensen, Søren L.

In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 21, No. 8, 01.08.2019, p. 1203-1210.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - The effect of implantable cardioverter-defibrillator in patients with diabetes and non-ischaemic systolic heart failure

AU - Rørth, Rasmus

AU - Thune, Jens Jakob

AU - Nielsen, Jens C

AU - Haarbo, Jens

AU - Videbæk, Lars

AU - Korup, Eva

AU - Signorovitch, James

AU - Bruun, Niels E

AU - Eiskjær, Hans

AU - Hassager, Christian

AU - Svendsen, Jesper Hastrup

AU - Høfsten, Dan E

AU - Torp-Pedersen, Christian

AU - Pehrson, Steen

AU - Køber, Lars

AU - Kristensen, Søren L

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - AIMS: Implantable cardioverter-defibrillator (ICD) implantation reduce the risk of sudden cardiac death, but not all-cause death in patients with non-ischaemic systolic heart failure (HF). Whether co-existence of diabetes affects ICD treatment effects is unclear.METHODS AND RESULTS: We examined the effect of ICD implantation on risk of all-cause death, cardiovascular death, and sudden cardiac death (SCD) according to diabetes status at baseline in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial. Outcomes were analysed by use of cumulative incidence curves and Cox regressions models. Of the 1116 patients enrolled, 211 (19%) had diabetes at baseline. Patients with diabetes were more obese, had worse kidney function and more were in New York Heart Association Class III/IV. The risk of device infections and other complications in the ICD group was similar among patients with and without diabetes (6.1% vs. 4.6% P = 0.54). Irrespective of treatment group, diabetes was associated with higher risk of all-cause death, cardiovascular death, and SCD. The treatment effect of ICD in patients with diabetes vs. patients without diabetes was hazard ratio (HR) = 0.92 (0.57-1.50) vs. HR = 0.85 (0.63-1.13); Pinteraction = 0.60 for all-cause mortality, HR = 0.99 (0.58-1.70) vs. HR = 0.70 (0.48-1.01); Pinteraction = 0.25 for cardiovascular death, and HR = 0.81 (0.35-1.88) vs. HR = 0.40 (0.22-0.76); Pinteraction = 0.16 for sudden cardiac death.CONCLUSION: Among patients with non-ischaemic systolic HF, diabetes was associated with higher incidence of all-cause mortality, primarily driven by cardiovascular mortality including SCD. Treatment effect of ICD therapy was not significantly modified by diabetes which might be due to lack of power.

AB - AIMS: Implantable cardioverter-defibrillator (ICD) implantation reduce the risk of sudden cardiac death, but not all-cause death in patients with non-ischaemic systolic heart failure (HF). Whether co-existence of diabetes affects ICD treatment effects is unclear.METHODS AND RESULTS: We examined the effect of ICD implantation on risk of all-cause death, cardiovascular death, and sudden cardiac death (SCD) according to diabetes status at baseline in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial. Outcomes were analysed by use of cumulative incidence curves and Cox regressions models. Of the 1116 patients enrolled, 211 (19%) had diabetes at baseline. Patients with diabetes were more obese, had worse kidney function and more were in New York Heart Association Class III/IV. The risk of device infections and other complications in the ICD group was similar among patients with and without diabetes (6.1% vs. 4.6% P = 0.54). Irrespective of treatment group, diabetes was associated with higher risk of all-cause death, cardiovascular death, and SCD. The treatment effect of ICD in patients with diabetes vs. patients without diabetes was hazard ratio (HR) = 0.92 (0.57-1.50) vs. HR = 0.85 (0.63-1.13); Pinteraction = 0.60 for all-cause mortality, HR = 0.99 (0.58-1.70) vs. HR = 0.70 (0.48-1.01); Pinteraction = 0.25 for cardiovascular death, and HR = 0.81 (0.35-1.88) vs. HR = 0.40 (0.22-0.76); Pinteraction = 0.16 for sudden cardiac death.CONCLUSION: Among patients with non-ischaemic systolic HF, diabetes was associated with higher incidence of all-cause mortality, primarily driven by cardiovascular mortality including SCD. Treatment effect of ICD therapy was not significantly modified by diabetes which might be due to lack of power.

U2 - 10.1093/europace/euz114

DO - 10.1093/europace/euz114

M3 - Journal article

C2 - 31323662

VL - 21

SP - 1203

EP - 1210

JO - Europace

JF - Europace

SN - 1099-5129

IS - 8

ER -