Publication:
Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study

dc.contributor.coauthorSahin, Anil
dc.contributor.coauthorCelik, Ahmet
dc.contributor.coauthorColluoglu, Inci Tugce
dc.contributor.coauthorAta, Naim
dc.contributor.coauthorKanik, Emine Arzu
dc.contributor.coauthorUlgu, Mustafa Mahir
dc.contributor.coauthorBirinci, Suayip
dc.contributor.coauthorYilmaz, Mehmet Birhan
dc.contributor.departmentSchool of Medicine
dc.contributor.kuauthorUral, Dilek
dc.contributor.schoolcollegeinstituteSCHOOL OF MEDICINE
dc.date.accessioned2025-03-06T20:57:41Z
dc.date.issued2024
dc.description.abstractBackgroundIn the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients.MethodsUtilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality.ResultsIn the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4%) in the GDMT group and 101 out of 619 patients (16.3%) in the ICD group, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) ranging from 0.57 to 0.98. The median follow-up time was 1365 days in the matched cohort, 1283 days in the GDMT group. Subgroup analyses consistently demonstrated benefits, particularly among individuals aged 61 years and older (HR: 0.60, 95% CI: 0.42-0.87, p = 0.006), those with sinus rhythm (HR: 0.55, 95% CI: 0.34-0.89, p = 0.013), individuals not using amiodarone (HR: 0.61, 95% CI: 0.42-0.89, p = 0.011), and those with an estimated glomerular filtration rate lower than 61.9 (HR: 0.66, 95% CI: 0.48-0.91, p = 0.011).ConclusionsThis study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF.
dc.description.indexedbyWOS
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.publisherscopeInternational
dc.description.sponsoredbyTubitakEuN/A
dc.identifier.doi10.1186/s12916-024-03761-w
dc.identifier.issn1741-7015
dc.identifier.issue1
dc.identifier.quartileQ1
dc.identifier.scopus2-s2.0-85209592382
dc.identifier.urihttps://doi.org/10.1186/s12916-024-03761-w
dc.identifier.urihttps://hdl.handle.net/20.500.14288/27276
dc.identifier.volume22
dc.identifier.wos1357244500002
dc.keywordsQuadruple guideline-directed medical therapy
dc.keywordsImplantable cardioverter-defibrillator
dc.keywordsMortality
dc.language.isoeng
dc.publisherBMC
dc.relation.ispartofBMC MEDICINE
dc.subjectMedicine
dc.titleImpact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study
dc.typeJournal Article
dspace.entity.typePublication
local.contributor.kuauthorUral, Dilek
local.publication.orgunit1SCHOOL OF MEDICINE
local.publication.orgunit2School of Medicine
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relation.isParentOrgUnitOfPublication17f2dc8e-6e54-4fa8-b5e0-d6415123a93e
relation.isParentOrgUnitOfPublication.latestForDiscovery17f2dc8e-6e54-4fa8-b5e0-d6415123a93e

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