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Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure

Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure,Jeanne E. Poole,George W. Johnson,Anne S. Hellkamp,Jill Anderson,David J.

Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure   (Citations: 39)
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Jeanne E. Poole, George W. Johnson, Anne S. Hellkamp, Jill Anderson, David J. Callans, Merritt H. Raitt, Ramakota K. Reddy, Francis E. Marchlinski, Raymond Yee, Thomas Guarnieri, Mario Talajic, David J. Wilberhttp://academic.research.microsoft.com/io.ashx?type=5&id=5319174&selfId1=0&selfId2=0&maxNumber=12&query=
Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox propor- tional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval (CI), 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as com- pared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P = 0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progres- sive heart failure. Conclusions Among patients with heart failure in whom an ICD is implanted for primary pre- vention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.
Published in 2010.
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