J Korean Med Sci.  2020 Dec;35(46):e397. 10.3346/jkms.2020.35.e397.

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

• Cho Y
• Cho SY
• Oh IY
• Lee JH
• Park JJ
• Lee HY
• Kim KH
• Yoo BS
• Kang SM
• Baek SH
• Jeon ES
• Kim JJ
• Cho MC
• Chae SC
• Oh BH
• Choi DJ

• KMID: 2509038
• DOI: http://doi.org/10.3346/jkms.2020.35.e397

Abstract

Background
There are sparse data on the utilization rate of implantable cardioverterdefibrillator (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 underutilization 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.

Keyword

Implantable Cardioverter-defibrillator; Heart Failure

Figure

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  Fig. 1 Flowchart of the study population.KorAHF = The Korean Acute Heart Failure registry, ICD = implantable cardioverter-defibrillator, EchoCG = echocardiography, LVEF = left ventricular ejection fraction.

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  Fig. 2 All-cause mortality according to the ICD implantation during follow-up. (A) In the matched study population, and (B) after excluding patients with CRT-D and their matched controls.ICD = implantable cardioverter-defibrillator, HR = hazard ratio, CI = confidence interval.

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