Impact of implantable cardioverter defibrillators on survival and recurrent hospitalization in advanced heart failure

Background Although implantable cardioverter defibrillators (ICDs) are increasingly used in advanced (class III/IV) heart failure, their benefits may be limited by death from pump failure and data are limited. The aim of this study was to assess the impact of QRS duration and disease etiology on survival and rehospitalization in advanced heart failure patients with ICDs. Methods A retrospective study of 438 patients with heart failure (age 56 ± 15, ejection fraction 29 ± 15, 76% class III/IV) discharged between 1996 and 2000 was performed. Results An ICD was placed in 94 of the 438 patients for nonsustained (51.1%) or sustained (24.4%) ventricular arrhythmia, syncope (16.0%), or prophylaxis (8.5%). Patients with ICDs had a lower mean baseline ejection fraction (25% vs 30%, P = .007) but a trend toward fewer class IV symptoms (33% vs 44%, P = .164). Patients with ICDs had better survival (RR 0.48, P = .001) but increased rehospitalization (RR 1.41, P = .031). In both the ischemic and nonischemic subgroups, survival was superior in patients with ICDs (RR 0.38, P = .003 and RR 0.54, P = .042). Patients with QRS <120 milliseconds had a trend toward better survival with an ICD (RR 0.42, P = .119) but increased rehospitalization (RR 2.13, P = .021). Patients with QRS ≥120 milliseconds had better survival with an ICD (RR 0.45, P = .001) without increased risk of rehospitalization (RR 1.22, P = .314). Conclusions Patients with advanced heart failure selected to receive ICDs have better survival trends but shorter time to rehospitalization than patients without ICDs. Benefit appears greater for those with prolonged QRS duration.