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- Title
Effect of Significant Weight Change on Inappropriate Implantable Cardioverter-Defibrillator Therapy.
- Authors
DAIMEE, USAMA A.; BITON, YITSCHAK; AKTAS, MEHMET K.; ZANNAD, FAIEZ; KLEIN, HELMUT; SZEPIETOWSKA, BARBARA; MCNITT, SCOTT; POLONSKY, BRONISLAVA; WANG, PAUL J.; ZAREBA, WOJCIECH; MOSS, ARTHUR J.; KUTYIFA, VALENTINA
- Abstract
Background Weight loss has been associated with adverse outcomes among heart failure (HF) patients, including those receiving cardiac resynchronization therapy with defibrillator (CRT-D). The effect of significant weight change on inappropriate implantable cardioverter-defibrillator (ICD) therapy among CRT-D patients is not well understood. Methods We evaluated the impact of significant weight change at 1 year on subsequent inappropriate ICD therapy during follow-up among 993 CRT-D patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy. Patients were divided into three subgroups based on weight change at 1 year after enrollment: weight loss (weight loss ≥ 5%), weight gain (weight gain ≥ 5%), and stable weight (weight loss and weight gain < 5%). The primary end point was inappropriate ICD therapy. Secondary end point included inappropriate ICD therapy related to supraventricular arrhythmias (SVAs). Results There were 102 (10.3%) patients who experienced weight loss, 689 (69.4%) whose weight was stable, and 202 (20.3%) who gained weight at 1 year. Patients with weight loss had increased risk of subsequent inappropriate ICD therapy relative to patients with stable weight (hazard ratio [HR] = 2.35, 95% confidence interval [CI]: 1.39-3.98, P = 0.001) or weight gain (HR = 2.27, 95% CI: 1.18-4.38, P = 0.014). Furthermore, patients losing weight were at greater risk of subsequent inappropriate ICD therapy related to SVAs when compared to patients with stable weight (HR = 2.16, 95% CI: 1.18-3.95, P = 0.013) or weight gain (HR = 2.02, 95% CI: 0.95-4.29, P = 0.068). Conclusion In mild HF patients receiving CRT-D, significant weight loss at 1 year is associated with increased risk of subsequent inappropriate ICD therapy, including risk related to SVAs.
- Subjects
BODY weight; CARDIAC pacing; CHI-squared test; CONFIDENCE intervals; ECHOCARDIOGRAPHY; FISHER exact test; HEART failure; IMPLANTABLE cardioverter-defibrillators; LONGITUDINAL method; MEDICAL errors; MULTIVARIATE analysis; PROBABILITY theory; RESEARCH funding; STATISTICAL hypothesis testing; WEIGHT loss; WEIGHT gain; SECONDARY analysis; PROPORTIONAL hazards models; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator; SUPRAVENTRICULAR tachycardia; LOG-rank test; ODDS ratio
- Publication
Pacing & Clinical Electrophysiology, 2017, Vol 40, Issue 1, p9
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.12973