Effect of Implantable Cardioverter-defibrillators in Nonischemic Heart Failure According to Background Medical Therapy: Extended Follow-up of the DANISH Trial

• Published in: Journal of cardiac failure Vol. 30; no. 11; pp. 1411 - 1420
• Main Authors: YAFASOVA, ADELINA, DOI, SEIKO N., THUNE, JENS JAKOB, NIELSEN, JENS C., HAARBO, JENS, BRUUN, NIELS E., GUSTAFSSON, FINN, EISKJÆR, HANS, HASSAGER, CHRISTIAN, SVENDSEN, JESPER H., HØFSTEN, DAN E., TORP-PEDERSEN, CHRISTIAN, PEHRSON, STEEN, KØBER, LARS, BUTT, JAWAD H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2024
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; DANISH; Defibrillators, Implantable; Denmark - epidemiology; Female; Follow-Up Studies; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - therapy; Humans; Implantable cardioverter-defibrillator; Male; Middle Aged; Mineralocorticoid Receptor Antagonists - therapeutic use; nonischemic heart failure; pharmacotherapy; Stroke Volume - physiology; Treatment Outcome; Denmark; HFC; DAPA-HF; pharmacotherapy; mHFC; nonischemic heart failure; Implantable cardioverter-defibrillator; DANISH
• ISSN: 1071-9164; 1532-8414; 1532-8414
• DOI: 10.1016/j.cardfail.2024.04.017

•In an extended follow-up study of the DANISH trial, lower dosages of pharmacological therapy (as assessed by the modified Heart Failure Collaboratory medical therapy score) were associated with higher rates of all-cause death, cardiovascular death and sudden cardiovascular death.•ICD implantation did not reduce all-cause mortality rates, but it did reduce sudden cardiovascular death in patients with nonischemic HFrEF, regardless of pharmacological therapy at baseline.•Our results underline the potential patient-related effects of underuse of guideline-recommended medical therapies in patients with nonischemic HFrEF. The Heart Failure Collaboratory (HFC) score integrates types and dosages of guideline-directed pharmacotherapies for heart failure (HF) with reduced ejection fraction (HFrEF). We examined the effects of cardioverter-defibrillator (ICD) implantation according to the modified HFC (mHFC) score in 1116 patients with nonischemic HFrEF from the Danish Study to Assess the Efficacy of ICDs in Patients with Nonischemic Systolic HF on Mortality (DANISH). Patients were assigned scores for renin-angiotensin-system inhibitors, beta-blockers and mineralocorticoid receptor antagonists (0, no use; 1, < 50% of maximum dosage; 2, ≥ 50% of maximum dosage). The maximum score was 6, corresponding to ≥ 50% of maximum dosage for all therapies. The median baseline mHFC score was 4, and the median follow-up was 9.5 years. Compared with an mHFC score of 3–4, an mHFC score of 1–2 was associated with a higher rate of all-cause death (mHFC = 1–2: adjusted HR 1.67 [95% CI, 1.23–2.28]; mHFC = 3–4, reference; mHFC = 5–6: adjusted HR 1.07 [95% CI, 0.87–1.31]). ICD implantation did not reduce all-cause death compared with control (reference) (HR 0.89 [95% CI, 0.74–1.08]), regardless of mHFC score (mHFC = 1–2: HR 0.98 [95% CI, 0.56–1.71]; mHFC = 3-4: HR 0.89 [95% CI,0.66–1.20]; mHFC = 5–6: HR 0.85 [95% CI, 0.64–1.12]; Pinteraction, 0.65). Similarly, ICD implantation did not reduce cardiovascular death (HR 0.87 [95% CI, 0.70–1.09]), regardless of mHFC score (Pinteraction, 0.59). The ICD group had a lower rate of sudden cardiovascular death (HR, 0.60 [95% CI,0.40–0.92]); this association was not modified by mHFC score (Pinteraction, 0.35). Lower mHFC scores were associated with higher rates of all-cause death. ICD implantation did not result in an overall survival benefit in patients with nonischemic HFrEF, regardless of mHFC score. [Display omitted]