Abstract
Background: COPD is a common comorbidity in heart failure. The efficacy of implantable cardioverter-defi brillator (ICD) therapy has not been determined in patients with heart failure and COPD. Methods: We examined the incidence of ICD shocks and mortality in 628 consecutive patients who underwent defi brillator implantation at the Minneapolis Veterans Affairs Medical Center from 2006 to 2010. Results: The mean age of the patients was 67 ± 10 years, and 99% were men. Patients with COPD (n = 246 [39%]) were functionally more limited (P <.0001) and more likely to have an ICD for primary prevention of sudden death (P = .04) than those without COPD. Over a median 4.1 years (interquartile range [IQR] 2.2-5.7) of follow-up, patients with COPD had a higher incidence of appropriate shocks than those without COPD (29% vs 17%; P <.0001), whereas the incidence of inappropriate shocks was similar (9% vs 10%, P = .61). In multivariable analysis, COPD was associated with a twofold increase in the odds of an appropriate ICD shock (95% CI, 1.3-2.9; P = .001). Incidence of ICD shocks did not vary with severity of COPD. Although all-cause mortality was higher in patients with COPD than in those without COPD (29% vs 21%, P = .029), 1-year mortality (5.3% vs 2.6%, P = .08) and the average time from fi rst appropriate ICD shock to death was comparable (median, 2.3 [IQR, 1.2-4.4] vs 2.8 [IQR, 1.4-5.3] years; P = .29). Conclusions: Patients with COPD have a higher incidence of ICD shocks than those without COPD and appear to benefi t from ICD therapy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 778-783 |
| Number of pages | 6 |
| Journal | CHEST |
| Volume | 144 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2013 |
Bibliographical note
Funding Information:Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Benditt is a consultant for and has equity with Medtronic, Inc; St. Jude Medical, Inc; and CardioNet. He also has equity with Boston Scientific, is a consultant for Nanostim, Inc, and has equity with and serves on the board of directors for Advanced Circulatory. Dr Adabag has received investigator-initiated research grants from Medtronic, Inc, and Boston Scientific. Drs Naksuk, Kunisaki, and Tholakanahalli have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.