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ICD May Not Help HFrEF Patients with CKD

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Dr Ramesh Hotchandani    12 February 2018

Implantable cardioverter defibrillator (ICD) therapy was found not to be associated with better outcomes in heart failure with reduced ejection fraction (HFrEF) complicated by chronic kidney disease (CKD) in a retrospective cohort study published online in JAMA Internal Medicine. Survival rates were same among the patients who got ICDs or went without it (all-cause mortality 14.9 versus 13.6 per 100 person-years, adjusted HR 0.96, 95% CI 0.87-1.06). This study included 5,877 HFrEF patients with CKD. CKD was moderate among the cohort, based on estimated glomerular filtration rates (eGFRs). It was noted that with an ICD, there was a greater risk of subsequent hospitalization due to heart failure (16.90 versus 11.12 per 100 person-years, adjusted RR 1.49, 95% CI 1.33-1.60) and hospitalization for any cause (51.65 versus 38.27 per 100 person-years, adjusted RR 1.25, 95% CI 1.20-1.30). Investigators stated that while ICD placement can reduce the risk of arrhythmic events in certain groups, patients with heart failure continue to be at high risk for recurrent hospitalizations. Additionally, ICDs have known complications (e.g., ICD device infections) that may result in higher rates of hospitalization overall.

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