Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings
Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings
Data
2015
Autores
Migowski, Arn
Ribeiro, Antonio Luiz
Carvalho, Marilia Sá
Azevedo, Vitor Manuel Pereira
Chaves, Rogério Brant Martins
Hashimoto, Lucas de Aquino
Xavier, Carolina de Aquino
Xavier, Regina Maria de Aquino
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Cardiovascular Disorders
Resumo
Background: The efficacy of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System (SUS).
Methods: All patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto’s test. Prognostic factors were selected using Cox’s models.
Results: There were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas’ heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of
CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation (5.3%) than those undergoing transvenous implantation (1.6%) (p = 0.02).
Conclusions: The results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.
Description
Palavras-chave
Implantable defibrillators, Cardiac resynchronization therapy devices, Chagas cardiomyopathy, Survival analysis, Medical record linkage, Technology assessment, Hospital mortality, High-cost technology
Citação
Migowski A, Ribeiro AL, Carvalho MS, Azevedo VMP, Chaves RBM, Hashimoto LA et al. Seven years of use of implantable cardioverter-defibrillator therapies: a nationwide population-based assessment of their effectiveness in real clinical settings. BMC Cardiovasc Disorder 2015 Mar;13;15(22). doi: 10.1186/s12872-015-0016-2. PMID: 25888219; PMCID: PMC4364497.