Efficacy of medical therapy for the reduction of heart failure events in patients with implanted cardioverter defibrillators

Grzegorz Pietrasik, Ilan Goldenberg, Scott McNitt, Bronislava Polonsky, Arthur J. Moss, Wojciech Zareba*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Efficacy of Medical Therapy for the Reduction of HF Events. Background: Prophylactic therapy with the implantable cardioverter defibrillator (ICD) reduces the mortality among patients with left ventricular dysfunction; however, life-prolonging device therapy has been shown to be associated with an increased risk for subsequent heart failure (HF) events. There are limited data on the effect of the primary types of HF medications, angiotensin converting enzyme inhibitors (ACE-I), and beta-blockers on HF progression in ICD-treated patients. Methods: Multivariate Cox proportional hazards regression analysis was used to assess the effect of time-dependent medical therapy with ACE-I and beta-blockers on the development of HF in patients with an ICD in the Multicenter Automatic Defibrillator Trail (MADIT) II. Results: In multivariate analysis, ICD therapy was associated with a significant 39% increase in the risk of HF as compared with conventional medical therapy. ACE-I and beta-blockers exhibited a graded efficacy for the reduction in the risk of HF events in ICD-treated patients: the greatest risk reduction of HF was seen in patients taking combination therapy (HR = 0.36, P < 0.001), followed by patients using beta-blockers only (HR = 0.51, P = 0.017) and ACE-I only (HR = 0.64, P = 0.071). Beta-blocker subtypes (metoprolol [HR = 0.49, P = 0.001] and carvedilol [HR = 0.58, P = 0.004]) exhibited similar efficacy. Consistent results were demonstrated when the combined endpoint of HF or death was assessed. Conclusions: ICD-treated patients experience an increased risk for HF events that can be significantly attenuated by medical therapy with beta-blockers and ACE-inhibitors.

Original languageEnglish
Pages (from-to)395-400
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

Keywords

  • Beta-adrenergic blockers
  • Heart failure
  • Implantable cardioverter defibrillator
  • Renin-angiotensin system
  • Sudden death

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