Arrhythmias & electrophysiologyMeta-analysis
Arrhythmia and Survival Outcomes Among Black Patients and White Patients With a Primary Prevention Defibrillator
- Pooled analysis of primary prevention implantable cardioverter-defibrillator (ICD) trials
- blinded event adjudication
- multivariable analysis
Authors' conclusion
Among patients with NICM with an ICD for primary prevention, Black patients compared with White patients had a high risk and burden of VTA, ATA, and ICD therapies with a lower survival rate. Nevertheless, the overall benefit of the ICD was maintained and was similar to that of White patients.
Study context
- Population
- US ICD recipients with ischemic or nonischemic cardiomyopathy enrolled in primary prevention ICD trials
- Participants
- 3,895 recipients
- Comparison
- Black vs White patients with a primary prevention ICD
- Outcome
- VTA, ATA, ICD therapies, VTA burden, death and predicted ICD benefit
Pooled result
As reported in the abstract
Black
32%
Ventricular tachyarrhythmia (VTA) ≥170 bpm · VTA ≥200 bpm 22% · atrial tachyarrhythmia (ATA) 25% · Appropriate therapy 30% · Inappropriate therapy 25%
White
20%
VTA ≥170 bpm · VTA ≥200 bpm 14% · ATA 12% · Appropriate therapy 20% · Inappropriate therapy 11%
- VTA ≥170 bpm, multivariable
- HR 1.71; P ≤ 0.01
- VTA ≥200 bpm, multivariable
- HR 1.58; P ≤ 0.01
- ATA, multivariable
- HR 1.87; P ≤ 0.01
- appropriate therapy, multivariable
- HR 1.62; P ≤ 0.01
- inappropriate therapy, multivariable
- HR 1.86; P ≤ 0.01
Further pooled results
| Outcome | HR | P value |
|---|---|---|
| Burden of tachyarrhythmias or therapies in NICM (Andersen-Gill) — Black vs White · VTA | 1.84 | P < 0.001 |
| Burden of tachyarrhythmias or therapies in NICM (Andersen-Gill) — Black vs White · appropriate therapy | 1.84 | P < 0.001 |
| Death in NICM | 1.92 | P = 0.014 |
Tachyarrhythmia, ICD therapy or death in ischemic cardiomyopathy
- Similar between Black and White patients
Benefit of ICD implantation
- Significant and similar benefit in Black and White patients
Original publication
Summarised from the published abstract; every number is checked against it