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Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) reduce the risk of sudden cardiac death among patients with persistently reduced (≤35 %) left ventricular ejection fraction (LVEF) at least 40 days following acute myocardial infarction (AMI). Few prior studies have used LVEF measured after...

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Autores principales: Judson, Gregory L., Cohen, Beth E., Muniyappa, Anoop, Raitt, Merritt H., Shen, Hui, Tarasovsky, Gary, Whooley, Mary A., Dhruva, Sanket S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601204/
https://www.ncbi.nlm.nih.gov/pubmed/37886349
http://dx.doi.org/10.1016/j.ahjo.2022.100186
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author Judson, Gregory L.
Cohen, Beth E.
Muniyappa, Anoop
Raitt, Merritt H.
Shen, Hui
Tarasovsky, Gary
Whooley, Mary A.
Dhruva, Sanket S.
author_facet Judson, Gregory L.
Cohen, Beth E.
Muniyappa, Anoop
Raitt, Merritt H.
Shen, Hui
Tarasovsky, Gary
Whooley, Mary A.
Dhruva, Sanket S.
author_sort Judson, Gregory L.
collection PubMed
description BACKGROUND: Implantable cardioverter-defibrillators (ICDs) reduce the risk of sudden cardiac death among patients with persistently reduced (≤35 %) left ventricular ejection fraction (LVEF) at least 40 days following acute myocardial infarction (AMI). Few prior studies have used LVEF measured after the 40-day waiting period to examine primary prevention ICD placement. METHODS: We sought to determine factors associated with ICD placement among patients who met LVEF criteria post-MI within a large integrated health care system in the U.S by conducting a retrospective cohort study of Veteran patients hospitalized for AMI from 2004 to 2017 who had documented LVEF ≤35 % from echocardiograms performed between 40 and 455 (90 days +1 year) days post-MI. We used multivariable logistic regression to examine factors associated with ICD placement. RESULTS: Of 12,893 patients with LVEF ≤35 % at least 40 days post-MI, 2176 (16.9 %) received an ICD between 91- and 455-days post-MI. Younger age, fewer comorbidities, revascularization with PCI, and greater use of GDMT were associated with increased odds of receiving an ICD. However, half of patients treated with a beta-blocker, ACE inhibitor or angiotensin receptor blocker, and mineralocorticoid receptor antagonist prior to LVEF assessment did not receive an ICD. Eligible Black patients were less likely (odds ratio 0.80, 95 % confidence interval 0.69–0.92) to receive an ICD than White patients. CONCLUSION: Many factors affect ICD placement among Veteran patients with a confirmed LVEF ≤35 % at least 40 days post-MI. Greater understanding of factors influencing ICD placement would help clinicians ensure guideline-concordant care.
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spelling pubmed-106012042023-10-26 Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction Judson, Gregory L. Cohen, Beth E. Muniyappa, Anoop Raitt, Merritt H. Shen, Hui Tarasovsky, Gary Whooley, Mary A. Dhruva, Sanket S. Am Heart J Plus Article BACKGROUND: Implantable cardioverter-defibrillators (ICDs) reduce the risk of sudden cardiac death among patients with persistently reduced (≤35 %) left ventricular ejection fraction (LVEF) at least 40 days following acute myocardial infarction (AMI). Few prior studies have used LVEF measured after the 40-day waiting period to examine primary prevention ICD placement. METHODS: We sought to determine factors associated with ICD placement among patients who met LVEF criteria post-MI within a large integrated health care system in the U.S by conducting a retrospective cohort study of Veteran patients hospitalized for AMI from 2004 to 2017 who had documented LVEF ≤35 % from echocardiograms performed between 40 and 455 (90 days +1 year) days post-MI. We used multivariable logistic regression to examine factors associated with ICD placement. RESULTS: Of 12,893 patients with LVEF ≤35 % at least 40 days post-MI, 2176 (16.9 %) received an ICD between 91- and 455-days post-MI. Younger age, fewer comorbidities, revascularization with PCI, and greater use of GDMT were associated with increased odds of receiving an ICD. However, half of patients treated with a beta-blocker, ACE inhibitor or angiotensin receptor blocker, and mineralocorticoid receptor antagonist prior to LVEF assessment did not receive an ICD. Eligible Black patients were less likely (odds ratio 0.80, 95 % confidence interval 0.69–0.92) to receive an ICD than White patients. CONCLUSION: Many factors affect ICD placement among Veteran patients with a confirmed LVEF ≤35 % at least 40 days post-MI. Greater understanding of factors influencing ICD placement would help clinicians ensure guideline-concordant care. 2022-07 /pmc/articles/PMC10601204/ /pubmed/37886349 http://dx.doi.org/10.1016/j.ahjo.2022.100186 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Article
Judson, Gregory L.
Cohen, Beth E.
Muniyappa, Anoop
Raitt, Merritt H.
Shen, Hui
Tarasovsky, Gary
Whooley, Mary A.
Dhruva, Sanket S.
Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction
title Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction
title_full Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction
title_fullStr Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction
title_full_unstemmed Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction
title_short Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction
title_sort implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601204/
https://www.ncbi.nlm.nih.gov/pubmed/37886349
http://dx.doi.org/10.1016/j.ahjo.2022.100186
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