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Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure

Open access
Poole, Jeanne E., Johnson, George W., Hellkamp, Anne S., Anderson, Jill, Callans, David J., Raitt, Merritt H., Reddy, Ramakota K., Marchlinski, Francis E., Yee, Raymond, Guarnieri, Thomas, Talajic, Mario, Wilber, David J., Fishbein, Daniel P., Packer, Douglas L., Mark, Daniel B., Lee, Kerry L., Bardy, Gust H.·2008·New England Journal of Medicine

Abstract

BACKGROUND: Patients with heart failure who receive an implantable cardioverter-defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about long-term prognosis after ICD therapy in such patients is limited. METHODS: Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate. RESULTS: Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P=0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure. CONCLUSIONS: Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.

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Metadata

Authors
Poole, J. E., Johnson, G. W., Hellkamp, A. S., Anderson, J., Callans, D. J., Raitt, M. H., Reddy, R. K., Marchlinski, F. E., Yee, R., Guarnieri, T., Talajic, M., Wilber, D. J., Fishbein, D. P., Packer, D. L., Mark, D. B., Lee, K. L., & Bardy, G. H.
Venue
New England Journal of Medicine
Published
2008-09-04
Volume
359
Issue
10
Pages
1009-1017
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2161984704
Cited by
1,462
References
5
FWCI
54.56
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure. https://app.cochat.ai/papers/10.1056/nejmoa071098
The paper
Poole, J. E., Johnson, G. W., Hellkamp, A. S., Anderson, J., Callans, D. J., Raitt, M. H., Reddy, R. K., Marchlinski, F. E., Yee, R., Guarnieri, T., Talajic, M., Wilber, D. J., Fishbein, D. P., Packer, D. L., Mark, D. B., Lee, K. L., & Bardy, G. H. (2008). Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure. New England Journal of Medicine. https://doi.org/10.1056/nejmoa071098

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.