Implantable cardioverter-defibrillators in patients with COPD

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)778-783
Number of pages6
JournalChest
Volume144
Issue number3
DOIs
StatePublished - Jan 1 2013

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Implantable Defibrillators
Chronic Obstructive Pulmonary Disease
Shock
Incidence
Mortality
Heart Failure
Veterans
Primary Prevention
Sudden Death
Comorbidity

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Implantable cardioverter-defibrillators in patients with COPD. / Naksuk, Niyada; Kunisaki, Ken M; Benditt, David G; Tholakanahalli, Venkatakrishna N; Adabag, Selcuk.

In: Chest, Vol. 144, No. 3, 01.01.2013, p. 778-783.

Research output: Contribution to journalArticle

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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.",
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AU - Naksuk, Niyada

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AU - Adabag, Selcuk

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N2 - 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.

AB - 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.

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