Implantable Cardioverter-Defibrillators in Patients Hospitalized for Heart Failure With Chronically Reduced Left Ventricular Ejection Fraction
Implantable Cardioverter-Defibrillators in Patients Hospitalized for Heart Failure With Chronically Reduced Left Ventricular Ejection Fraction
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DOI：
10.1097/mjt.0b013e3181e70a65
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发表时间：
2010-07-01
影响因子：
4.2
通讯作者：
Gheorghiade, Mihai
中科院分区：
文献类型：
--
作者：
Wang, Norman C.;Piccini, Jonathan P.;Gheorghiade, Mihai
本研究的目的是调查左心室射血分数降低的患者因心力衰竭（HF）恶化而住院时植入式心脏复律除颤器（ICD）状态与出院后事件之间的关联。我们对 EVEREST 中 4133 名因心力衰竭住院且左心室射血分数为 40% 或以下的患者进行了分析。最终分析包括入组时没有电生理设备的患者 (n = 3102) 和具有 ICD 的患者 (n = 600)。在中位随访 300 天期间，无装置组的全因死亡率为 22.9%，ICD 组为 35.2%（风险比 [HR]，1.62；95% 置信区间 [CI]，1.39-1.89）。无装置组因心力衰竭再住院的比例为 27.0%，ICD 组为 46.8%（HR，2.20；95% CI，1.92-2.52）。调整多个变量后，全因死亡率相似（HR，1.01；95% CI，0.83-1.22），但与无装置组相比，ICD 组心衰住院率较高（HR，1.35；95% CI，1.14-1.60）。在左心室射血分数降低的患者中，因心力衰竭恶化住院时使用 ICD 与死亡率相似，但因心力衰竭再住院率较高。鉴于我们的研究结果，进一步的研究应该调查已植入 ICD 的患者的护理优化，以及尚未植入的心衰患者住院期间或住院后不久 ICD 植入的作用。
The aim of this study was to investigate the association between implantable cardioverter-defibrillator (ICD) status at the time of hospitalization for worsening heart failure (HF) with postdischarge events in patients with reduced left ventricular ejection fraction. We conducted an analysis of 4133 patients hospitalized for HF with left ventricular ejection fraction 40% or less in EVEREST. The final analysis included patients without an electrophysiological device (n = 3102) and those with an ICD (n = 600) at the time of enrollment. During a median follow-up of 300 days, all-cause mortality was 22.9% in the no device group and 35.2% in the ICD group (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.39-1.89). Rehospitalization for HF was 27.0% in the no device group and 46.8% in the ICD group (HR, 2.20; 95% CI, 1.92-2.52). After adjustment for multiple variables, the rates for all-cause mortality were similar (HR, 1.01; 95% CI, 0.83-1.22), but the ICD group had elevated rates of HF hospitalizations compared with the no device group (HR, 1.35; 95% CI, 1.14-1.60). In patients with reduced left ventricular ejection fraction, an ICD at presentation for hospitalization for worsening HF was associated with similar rates of death but higher rates of rehospitalization for HF. Given our findings, further studies should investigate optimization of care in patients already implanted with an ICD as well as the role of ICD implantation during or soon after hospitalization for HF in patients not yet implanted.