Survival Similar for ICDs in Trials and Clinical Practice

Results observed in two clinical trials and similar patients in routine practice

THURSDAY, Jan. 3 (HealthDay News) -- Survival is similar for patients who receive implantable cardioverter-defibrillators (ICDs) as part of a randomized clinical trial or in routine clinical practice for primary prevention, according to research published in the Jan. 2 issue of the Journal of the American Medical Association.

Sana M. Al-Khatib, M.D., M.H.S., from the Duke University Medical Center in Durham, N.C., and colleagues compared survival for two groups of patients who had received ICDs: 742 patients from the MADIT-II randomized trial and 829 patients from the SCD-HeFT randomized trial. These patients were propensity score-matched with 2,464 and 3,352 patients from the National Cardiovascular Data Registry ICD Registry who met the criteria for MADIT-II and SCD-HeFT, respectively, and received an ICD in clinical practice.

After follow-ups ranging from 19.5 to 46.1 months, the researchers found that, for the MADIT-II patients, two-year mortality rates were similar for patients in the registry and the randomized trial (13.9 versus 15.6 percent; adjusted hazard ratio, 1.06; P = 0.62). For the SCD-HeFT patients, three-year mortality rates were also similar for patients in the registry and the randomized trial (17.3 versus 17.4 percent; adjusted hazard ratio, 1.16; P = 0.11). This was despite the fact that patients from the registry were significantly older and had more comorbidities than patients in the trials.

"Our findings support the continued use of primary prevention ICDs in similar patients seen in clinical practice," Al-Khatib and colleagues conclude.

Several authors disclosed financial ties to pharmaceutical and medical device companies.

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