BackgroundThere are conflicting data regarding the benefit of primary prevention implantable cardioverter‐defibrillators (ICDs) in patients with diabetes mellitus and heart failure (HF) with reduced ejection fraction. We aimed to assess the comparative effectiveness of ICD placement in patients with diabetes mellitus and HF with reduced ejection fraction.Methods and ResultsData were obtained from the Get With the Guidelines–Health Failure registry, linked with claims from the Centers for Medicare & Medicaid Services. We used a Cox proportional hazards model censored at 5 years with propensity score matching. Of the 17 186 patients with HF with reduced ejection fraction from the Centers for Medicare & Medicaid Services claims database (6540 with diabetes mellitus; 38%), 1677 (646 with diabetes mellitus; 39%) received an ICD during their index HF hospitalization or were prescribed an ICD at discharge. Patients with diabetes mellitus and an ICD (n=646), as compared with those without an ICD (n=1031), were more likely to be younger (74 versus 78 years of age) and have coronary artery disease (68% versus 60%). After propensity matching, ICD use among patients with diabetes mellitus, as compared with those without an ICD, was associated with a reduced risk of all‐cause mortality at 5 years after HF discharge (54% versus 59%; multivariable hazard ratio, 0.73; 95% CI, 0.64–0.82; P<0.0001). Ischemic heart disease did not modify the association between ICD use and all‐cause mortality (P=0.95 for interaction). Similar results were seen in patients without diabetes mellitus.ConclusionsPrimary prevention ICD use among older patients with HF with reduced ejection fraction and diabetes mellitus was associated with a reduced risk of all‐cause mortality. Our analysis supports current guideline recommendations for implantation of primary prevention ICDs among older patients with diabetes mellitus and HF with reduced ejection fraction.

中文翻译：

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植入式心脏复律除颤器对老年糖尿病心力衰竭患者一级预防的比较效果。


背景关于一级预防植入式心律转复除颤器（ICD）对射血分数降低的糖尿病和心力衰竭（HF）患者的益处，存在相互矛盾的数据。我们的目的是评估 ICD 放置在射血分数降低的糖尿病和心力衰竭患者中的​​相对有效性。方法和结果数据来自 Get With theGuidelines-Health Failure 登记处，与医疗保险和医疗补助服务中心的索赔相关。我们使用了 Cox 比例风险模型，通过倾向评分匹配进行 5 年审查。在医疗保险和医疗补助服务中心索赔数据库中，在 17 186 名射血分数降低的心力衰竭患者中（6540 名患有糖尿病；38%），其中 1677 名患者（646 名患有糖尿病；39%）在心力衰竭住院期间或出院时开了 ICD。与未安装 ICD 的患者 (n=1031) 相比，患有糖尿病并安装 ICD 的患者 (n=646) 更年轻（74 岁 vs 78 岁）并且患有冠状动脉疾病（68% vs 60%）。 %）。倾向匹配后，与未使用 ICD 的患者相比，糖尿病患者使用 ICD 与 HF 出院后 5 年全因死亡率风险降低相关（54% 对比 59%；多变量风险比为 0.73； 95% CI，0.64–0.82； P <0.0001)。缺血性心脏病并没有改变 ICD 使用与全因死亡率之间的关联（交互作用P = 0.95）。在没有糖尿病的患者中也出现了类似的结果。 结论 在射血分数降低且患有糖尿病的老年心力衰竭患者中，一级预防 ICD 的使用与全因死亡率风险降低相关。 我们的分析支持当前关于在患有糖尿病和射血分数降低的心力衰竭的老年患者中植入一级预防 ICD 的指南建议。