AIMS: Implantable cardioverter-defibrillator (ICD) implantation reduce the
risk of
sudden cardiac death , but not all-cause
death in
patients with non-ischaemic
systolic heart failure (HF). Whether co-existence of
diabetes affects ICD
treatment effects is unclear.
We examined the effect of ICD implantation on
risk of all-cause
death , cardiovascular
death , and
sudden cardiac death (SCD) according to
diabetes status at baseline in the Danish Study to Assess the
Efficacy of ICDs in
Patients with Non-ischaemic
Systolic Heart Failure on
Mortality (DANISH) trial. Outcomes were analysed by use of cumulative
incidence curves and Cox regressions models. Of the 1116
patients enrolled, 211 (19%) had
diabetes at baseline.
Patients with
diabetes were more obese, had worse
kidney function and more were in
New York Heart Association Class III/IV. The
risk of
device infections and other complications in the ICD group was
similar among
patients with and without
diabetes (6.1% vs. 4.6% P = 0.54). Irrespective of
treatment group,
diabetes was associated with higher
risk of all-cause
death , cardiovascular
death , and SCD. The
treatment effect of ICD in
patients with
diabetes vs.
patients without
diabetes was
hazard ratio (HR) = 0.92 (0.57-1.50) vs. HR = 0.85 (0.63-1.13); Pinteraction = 0.60 for all-cause
mortality , HR = 0.99 (0.58-1.70) vs. HR = 0.70 (0.48-1.01); Pinteraction = 0.25 for cardiovascular
death , and HR = 0.81 (0.35-1.88) vs. HR = 0.40 (0.22-0.76); Pinteraction = 0.16 for
sudden cardiac death .
CONCLUSION: Among
patients with non-ischaemic systolic HF,
diabetes was associated with higher
incidence of all-cause
mortality , primarily driven by cardiovascular
mortality including SCD.
Treatment effect of ICD
therapy was not significantly modified by
diabetes which might be due to lack of
power .