Appropriate shocks and mortality in patients with versus without diabetes with prophylactic implantable cardioverter defibrillators

for the EU-CERT-ICD Investigators

Research output: Contribution to journalArticle

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 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 6 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 6 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 5 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11-1.53], P 5 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.

Original languageEnglish
Pages (from-to)196-200
Number of pages5
JournalDiabetes care
Volume43
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

Fingerprint

Implantable Defibrillators
Shock
Mortality
Sudden Cardiac Death
Incidence
Sudden Death
Left Ventricular Function
Tachycardia
Registries
Research Design
Survival

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Appropriate shocks and mortality in patients with versus without diabetes with prophylactic implantable cardioverter defibrillators. / for the EU-CERT-ICD Investigators.

In: Diabetes care, Vol. 43, No. 1, 01.01.2020, p. 196-200.

Research output: Contribution to journalArticle

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title = "Appropriate shocks and mortality in patients with versus without diabetes with prophylactic implantable cardioverter defibrillators",
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 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 6 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 6 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 5 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95{\%} CI 1.11-1.53], P 5 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.",
author = "{for the EU-CERT-ICD Investigators} and {Juhani Junttila}, M. and Ari Pelli and Kentt{\"a}, {Tuomas V.} and Tim Friede and Rik Willems and Leonard Bergau and Marek Malik and Bert Vandenberk and Vos, {Marc A.} and Georg Schmidt and Bela Merkely and Andrzej Lubinski and Martin Svetlosak and Frieder Braunschweig and Markus Harden and Markus Zabel and Huikuri, {Heikki V.} and Christian Sticherling",
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T1 - Appropriate shocks and mortality in patients with versus without diabetes with prophylactic implantable cardioverter defibrillators

AU - for the EU-CERT-ICD Investigators

AU - Juhani Junttila, M.

AU - Pelli, Ari

AU - Kenttä, Tuomas V.

AU - Friede, Tim

AU - Willems, Rik

AU - Bergau, Leonard

AU - Malik, Marek

AU - Vandenberk, Bert

AU - Vos, Marc A.

AU - Schmidt, Georg

AU - Merkely, Bela

AU - Lubinski, Andrzej

AU - Svetlosak, Martin

AU - Braunschweig, Frieder

AU - Harden, Markus

AU - Zabel, Markus

AU - Huikuri, Heikki V.

AU - Sticherling, Christian

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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 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 6 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 6 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 5 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11-1.53], P 5 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.

AB - 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 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 6 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 6 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 5 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11-1.53], P 5 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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U2 - 10.2337/dc19-1014

DO - 10.2337/dc19-1014

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SN - 1935-5548

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