22 ICD Insertion Confers Reduced Mortality and Improved Survival in Patients with Dilated Cardiomyopathy: Real-Life Data from Manchester, UK, 2000–2013

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Abstract

Introduction

Dilated cardiomyopathy (DCM) is associated with adverse mortality. A high percentage of deaths from DCM are sudden, mostly due to ventricular arrhythmias. RCTs have shown that insertion of implantable cardioverter defibrillators (ICD) reduce mortality in these patients. However, the insertion of these devices in the UK is still directed by national guidelines and cost. Real-life data showing the mortality benefit of ICD insertions in patients with DCM in UK is lacking. Objectives: We evaluated long-term mortality and survival in patients with DCM from a large sample from Manchester, UK.

Methods

Anonymous information on patients with DCM, co-morbidities and procedures attending seven-hospitals in Manchester, UK in the period 2000–2013 was obtained from the local-health-authority-computerised hospital-activity-analysis-register using ICD-10 and OPCS coding-systems. Logistic-regression-analysis was used for predictors of mortality and survival was determined by Kaplan-Meier-curves.

Results

Over the time period, there were 725 patients with DCM; mean age 53.9 years ± 15.5 (S.D); Male (530,73.1%), Female (195, 26.0%). Of these 198 patients died (27.3%). The main co-morbidities were Heart Failure (400; 55.2%), Atrial Fibrillation (249; 34.3%), Hypertension (248; 34.2%), Ischaemic Heart Disease (144; 19.9%), Type 2 Diabetes Mellitus (126; 17.4%), Chronic Kidney Disease (70; 9.7%). 43 patients (5.9%) had ventricular tachyarrhythmias and 47patients(6.5%) had ICD inserted. A logistic-regression-model showed only increasing age (RR1.02; C.I1.01–1.03), Ischaemic Heart Disease (RR1.97; C.I 1.21–3.21) and Chronic Kidney Disease (RR4.73; C.I2.51–8.91) to be significant predictors of worsened mortality in this population. Insertion of ICD (RR0.16; C.I0.06–0.48) and Hypertension (RR0.61; C.I0.39–0.96) were found to be significant predictors of improved mortality (Figure 1).

Conclusion

In a large real-life patient dataset covering a 13 year-period, we have shown that ICD-insertion improves long-term survival and mortality in DCM patients. Presence of Hypertension also confers benefit possibly reflecting the mortality benefit of antihypertensive medications such as beta-blockers and angiotensin-converting-enzyme-inhibitors. We acknowledge the limitations of these data, such as lack of patient-specific information including ejection-fraction, symptoms and functional-status. Nevertheless, the presence of an ICD in these patients appears to confer real-life-mortality benefits which should be taken into consideration whilst deliberating about ICD-insertion.

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