Appropriate shocks and mortality in patients with versus without diabetes with prophylactic implantable cardioverter defibrillators
Juhani Junttila, M.; Pelli, Ari; Kenttä, Tuomas V.; Friede, Tim; Willems, Rik; Bergau, Leonard; Malik, Marek; Vandenberk, Bert; Vos, Marc A.; Schmidt, Georg; Merkely, Bela; Lubinski, Andrzej; Svetlosak, Martin; Braunschweig, Frieder; Harden, Markus; Zabel, Markus; Huikuri, Heikki V.; Sticherling, Christian; for the EU-CERT-ICD Investigators
(2020) Diabetes Care, volume 43, issue 1, pp. 196 - 200
(Article)
Abstract
OBJECTIVE: Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in
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the retrospective EU-CERT-ICD registry. RESEARCH DESIGN AND METHODS AND RESULTS: A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62-0.96], P = 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11-1.53], P = 0.001). CONCLUSIONS: All-cause mortality is higher in patients with diabetes than in patients without diabetes with primary prophylactic ICDs. Subsequently, patients with diabetes have a lower incidence of appropriate ICD shocks, indicating that the excess mortality might not be caused primarily by ventricular tachyarrhythmias. These findings suggest a limitation of the potential of prophylactic ICD therapy to improve survival in patients with diabetes with impaired left ventricular function.
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Keywords: Advanced and Specialised Nursing, Internal Medicine, Endocrinology, Diabetes and Metabolism, Journal Article
ISSN: 0149-5992
Publisher: American Diabetes Association Inc.
Note: Funding Information: The EU-CERT-ICD project is funded by the European Community’s 7th Framework Program FP7/2007–2013 (grant agreement number 602299). The prospective arm (clinicaltrials.gov NCT02064192) has enrolled 2,327 patients with an indication for a primary prevention ICD implantation who will also undergo an analysis of numerous candidate electrocardiogram variables from 12-lead Holter recordings as potential markers for a higher risk of malignant arrhythmias. Our data stem from an associated work package 02 within the project, a retrospective compilation of 14 locally existing registries of primary prevention ICD implantations between 2002 and 2014. The study design has already been described in Sticherl-ing et al. (10). In this analysis, we only consider data from 12 out of 14 centers, since diabetes status was only available for those centers (10). Diabetes was diagnosed according to the World Health Organization guidelines in all centers. Funding Information: Funding. The EU-CERT-ICD project is funded by the European Community’s 7th Framework Programme FP7/2007–2013 (grant agreement number 602299). Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. M.J.J. collected the patient population and wrote the manuscript. A.P. collected data and reviewed and edited the manuscript. T.V.K. and M.A.V. analyzed data and reviewed and edited the manuscript. T.F. and M.H. performed statistical analyses and reviewed and edited the manuscript. R.W., L.B., B.V., G.S., B.M., A.L., M.S., and F.B. collected the patient population and reviewed and edited the manuscript. M.M. analyzed data, reviewed grammar, and reviewed and edited the manuscript. M.Z. collected the patient population, supervised the project and funding, and reviewed and edited the manuscript. H.V.H. and C.S. supervised and collected the patient population and reviewed and edited the manuscript. T.F. and M.H. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation. This study was presented in poster form at the 2018 European Society of Cardiology Congress, Munich, Germany, 25–29 August 2018, and the Heart Rhythm Society’s 39th Annual Scientific Sessions, Boston, MA, 9– 12 May 2018. Funding Information: The EU-CERT-ICD project is funded by the European Community's 7th Framework Programme FP7/2007-2013 (grant agreement number 602299). Publisher Copyright: © 2019 by the American Diabetes Association.
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