Global and Temporal Trends in Utilization and Outcomes of Implantable Cardioverter Defibrillators in Hypertrophic Cardiomyopathy.

IF 9.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation. Arrhythmia and electrophysiology Pub Date : 2025-02-01 Epub Date: 2025-02-03 DOI:10.1161/CIRCEP.124.013479

Omar M Abdelfattah, Ahmed Sayed, Ahmed Al-Jwaid, Ahmed Hassan, Deaa Abu Jazar, Arun Narayanan, Mark S Link, Matthew W Martinez

{"title":"Global and Temporal Trends in Utilization and Outcomes of Implantable Cardioverter Defibrillators in Hypertrophic Cardiomyopathy.","authors":"Omar M Abdelfattah, Ahmed Sayed, Ahmed Al-Jwaid, Ahmed Hassan, Deaa Abu Jazar, Arun Narayanan, Mark S Link, Matthew W Martinez","doi":"10.1161/CIRCEP.124.013479","DOIUrl":null,"url":null,"abstract":"Background: Over the past decades, hypertrophic cardiomyopathy has become a contemporary treatable disease. However, limited data exist on the global trends of implantable cardioverter defibrillator (ICD) utilization and its impact on mortality/morbidity burden reduction.Methods: Electronic databases were systematically searched up to March 2024 for studies reporting on ICD utilization rates in hypertrophic cardiomyopathy. A random effects model was used to pool study estimates across time-era, geographic region, and age group. Primary outcome was global trends in ICD utilization. Secondary outcomes included trends of sudden cardiac death, appropriate/inappropriate shocks, and ICD-related complications.Results: In total, 234 studies (N=92 500, 514 748 patient-years) met inclusion criteria. Mean age was 46.2 (12.4) years and 37.49% were women. A total of 12 139 patients (16.43%) received an ICD over 429 766 person-years of follow-up, with an ICD implantation rate of 2.79%/y ([95% CI, 2.35%-3.32%] I²=97.80%). Rates of ICD implantation steadily increased over time from 1990 (1.09%) to 2021 (4.01%; P=0.002), with noticeable geographic variation (P=0.008). The overall rate of appropriate ICD discharges and ICD-related complications was 3.44%/y ([95% CI, 3.08%-3.84%] I²=88.40%) and 1.98%/y ([95% CI, 1.52%-2.59%] I²=90.44%), respectively, with no significant trend over time. The overall rate of inappropriate discharges was 3.58%/y ([95% CI, 3.08%-4.16%] I2=88.03%), and declined significantly over time (P=0.044). There was a significant decline in the rates of sudden cardiac death from 1990 (0.84%/y) to 2020 (0.31%/y).Conclusions: Dramatic increases in ICD utilization have occurred, representing a 3.7-fold increase, with appropriate therapies occurring in 3.44%/y. In parallel a significant reduction in sudden cardiac death was observed, but there are insufficient data to demonstrate that a causative relationship exists. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy.Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023407126.","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013479"},"PeriodicalIF":9.1000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837969/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation. Arrhythmia and electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCEP.124.013479","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/3 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Over the past decades, hypertrophic cardiomyopathy has become a contemporary treatable disease. However, limited data exist on the global trends of implantable cardioverter defibrillator (ICD) utilization and its impact on mortality/morbidity burden reduction.

Methods: Electronic databases were systematically searched up to March 2024 for studies reporting on ICD utilization rates in hypertrophic cardiomyopathy. A random effects model was used to pool study estimates across time-era, geographic region, and age group. Primary outcome was global trends in ICD utilization. Secondary outcomes included trends of sudden cardiac death, appropriate/inappropriate shocks, and ICD-related complications.

Results: In total, 234 studies (N=92 500, 514 748 patient-years) met inclusion criteria. Mean age was 46.2 (12.4) years and 37.49% were women. A total of 12 139 patients (16.43%) received an ICD over 429 766 person-years of follow-up, with an ICD implantation rate of 2.79%/y ([95% CI, 2.35%-3.32%] I²=97.80%). Rates of ICD implantation steadily increased over time from 1990 (1.09%) to 2021 (4.01%; P=0.002), with noticeable geographic variation (P=0.008). The overall rate of appropriate ICD discharges and ICD-related complications was 3.44%/y ([95% CI, 3.08%-3.84%] I²=88.40%) and 1.98%/y ([95% CI, 1.52%-2.59%] I²=90.44%), respectively, with no significant trend over time. The overall rate of inappropriate discharges was 3.58%/y ([95% CI, 3.08%-4.16%] I²=88.03%), and declined significantly over time (P=0.044). There was a significant decline in the rates of sudden cardiac death from 1990 (0.84%/y) to 2020 (0.31%/y).

Conclusions: Dramatic increases in ICD utilization have occurred, representing a 3.7-fold increase, with appropriate therapies occurring in 3.44%/y. In parallel a significant reduction in sudden cardiac death was observed, but there are insufficient data to demonstrate that a causative relationship exists. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023407126.

查看原文本刊更多论文

植入式心律转复除颤器在肥厚性心肌病中的使用和结果的全球和时间趋势。

背景：在过去的几十年里，肥厚性心肌病已经成为一种当代可治疗的疾病。然而，关于植入式心律转复除颤器（ICD）使用的全球趋势及其对减少死亡率/发病率负担的影响的数据有限。方法：系统检索截至2024年3月的电子数据库，检索有关肥厚性心肌病ICD使用率的研究报告。随机效应模型用于跨时间、地理区域和年龄组汇总研究估计。主要结果是ICD使用的全球趋势。次要结局包括心源性猝死、适当/不适当休克和icd相关并发症的趋势。结果：共有234项研究（N=92 500, 514 748患者-年）符合纳入标准。平均年龄46.2岁（12.4岁），女性占37.49%。在429766人-年的随访中，共有12139例患者（16.43%）接受了ICD， ICD植入率为2.79%/y （[95% CI, 2.35%-3.32%] I²=97.80%）。从1990年（1.09%）到2021年（4.01%），ICD植入率稳步上升；P=0.002)，地理差异显著（P=0.008）。ICD适当出院和ICD相关并发症的总发生率分别为3.44%/y （[95% CI, 3.08%-3.84%] I²=88.40%）和1.98%/y ([95% CI, 1.52%-2.59%] I²=90.44%)，随时间变化无明显趋势。总体不适当出院率为3.58%/y ([95% CI, 3.08% ~ 4.16%] I2=88.03%)，随时间推移显著下降（P=0.044）。从1990年（0.84%/年）到2020年（0.31%/年），心源性猝死率显著下降。结论：ICD使用率急剧增加，增加了3.7倍，适当治疗的发生率为3.44%/年。ICD的使用率急剧增加，增加了3.7倍，适当治疗的发生率为3.44%/年，同时观察到心源性猝死的显著减少，但没有足够的数据证明存在因果关系。ICD使用的地理差异是明显的，强调需要改善肥厚性心肌病患者获得专门护理的机会。ICD使用的地理差异是明显的，强调需要改善肥厚性心肌病患者获得专门护理的机会。注册：网址：https://www.crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42023407126。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Circulation. Arrhythmia and electrophysiology 医学-心血管系统

CiteScore

13.70

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.