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Implantable Cardioverter-defibrillator Utilization and Its Outcomes in Korea: Data from Korean Acute Heart Failure Registry

Journal of Korean Medical Science 2020년 35권 46호 p.397 ~ 397
조용진, 조상영, 오일영, 이지현, 박진주, 이해영, 김계훈, 유병수, 강석민, 백상홍, 전은석, 김재중, 조명찬, 채성철, 오병희, 최동주,
소속 상세정보
조용진 ( Cho Young-Jin ) - Seoul National University Bundang Hospital Department of Internal Medicine
조상영 ( Cho Sang-Yeong ) - Seoul National University Bundang Hospital Department of Internal Medicine
오일영 ( Oh Il-Young ) - Seoul National University Bundang Hospital Department of Internal Medicine
이지현 ( Lee Ji-Hyun ) - Seoul National University Bundang Hospital Department of Internal Medicine
박진주 ( Park Jin-Joo ) - Seoul National University Bundang Hospital Department of Internal Medicine
이해영 ( Lee Hae-Young ) - Seoul National University Hospital Department of Internal Medicine
김계훈 ( Kim Kye-Hun ) - Chonnam National University Hospital Heart Research Center Department of Internal Medicine
유병수 ( Yoo Byung-Su ) - Yonsei University Wonju College of Medicine Department of Internal Medicine
강석민 ( Kang Seok-Min ) - Yonsei University College of Medicine Department of Internal Medicine
백상홍 ( Baek Sang-Hong ) - Catholic University College of Medicine Department of Internal Medicine
전은석 ( Jeon Eun-Seok ) - Sungkyunkwan University School of Medicine Department of Internal Medicine
김재중 ( Kim Jae-Joong ) - University of Ulsan College of Medicine Department of Internal Medicine
조명찬 ( Cho Myeong-Chan ) - Chungbuk National University College of Medicine Department of Internal Medicine
채성철 ( Chae Shung-Chull ) - Kyungpook National University School of Medicine Department of Internal Medicine
오병희 ( Oh Byung-Hee ) - Seoul National University Hospital Department of Internal Medicine
최동주 ( Choi Dong-Ju ) - Seoul National University Bundang Hospital Department of Internal Medicine

Abstract


Background: There are sparse data on the utilization rate of implantable cardioverter-defibrillator (ICD) and its beneficial effects in Korean patients with heart failure with reduced left ventricular ejection fraction (LVEF).

Methods: Among 5,625 acute heart failure (AHF) patients from 10 tertiary university hospitals across Korea, 485 patients with reassessed LVEF ≤ 35% at least 3 months after the index admission were enrolled in this study. The ICD implantation during the follow-up was evaluated. Mortality was compared between patients with ICDs and age-, sex-, and follow-up duration matched control patients.

Results: Among 485 patients potentially indicated for an ICD for primary prevention, only 56 patients (11.5%) underwent ICD implantation during the follow-up. Patients with ICD showed a significantly lower all-cause mortality compared with their matched control population: adjusted hazard ratio (HR) (95% confidence interval [CI]) = 0.39 (0.16?0.92), P = 0.032. The mortality rate was still lower in the ICD group after excluding patients with cardiac resynchronization therapy (adjusted HR [95% CI] = 0.09 [0.01?0.63], P = 0.015). According to the subgroup analysis for ischemic heart failure, there was a significantly lower all-cause mortality in the ICD group than in the no-ICD group (HR [95% CI] = 0.20 [0.06?0.72], P = 0.013), with a borderline statistical significance (interaction P = 0.069).

Conclusion: Follow-up data of this large, multicenter registry suggests a significant under-utilization of ICD in Korean heart failure patients with reduced LVEF. Survival analysis implies that previously proven survival benefit of ICD in clinical trials could be extrapolated to Korean patients.

키워드

Implantable Cardioverter-defibrillator; Heart Failure

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