Heart failure & cardiomyopathiesMeta-analysis
Competing Risk of Ventricular Tachyarrhythmia and Nonarrhythmic Mortality in Advanced Heart Failure
- Pooled analysis of primary prevention implantable cardioverter-defibrillator (ICD) recipients from 5 major trials
- stratified by left ventricular ejection fraction (LVEF) tertiles
- Fine and Gray competing risk models
Authors' conclusion
Patients with very low LVEF have higher cumulative incidence of sustained VT/VF and ICD shocks, along with an increased competing risk of death. These findings suggest that LVEF is an important factor in the shared decision-making process for a primary prevention ICD.
Study context
- Population
- Primary prevention implantable cardioverter-defibrillator (ICD) recipients with heart failure and reduced LVEF from MADIT-II, MADIT-CRT, MADIT-RIT, MADIT-RISK and RAID
- Participants
- 5,168 patients
- Comparison
- LVEF tertiles; LVEF ≤20% vs LVEF >20%
Pooled result
Sustained VT/VF (cumulative incidence) · 3 years
Higher cumulative incidence
23%
P = 0.004
By group
As reported in the abstract
Further pooled results
| Outcome | Estimate | P value |
|---|---|---|
| Fast VT/VF (≥200 beats/min) · multivariable model; higher with LVEF ≤20% | higher cumulative incidence 33% | P = 0.001 |
| ICD shocks · multivariable model; higher with LVEF ≤20% | higher cumulative incidence 31% | P = 0.003 |
| All-cause mortality · increased with LVEF ≤20% | increased risk 1.5-fold | P < 0.001 |
Subgroups, cardiac resynchronization therapy-defibrillator use, cardiomyopathy etiology
- Associations similar across subgroups
Original publication
Competing Risk of Ventricular Tachyarrhythmia and Nonarrhythmic Mortality in Advanced Heart Failure. JACC Clin Electrophysiol. Published 2 April 2026. doi:10.1016/j.jacep.2026.02.028
Summarised from the published abstract; every number is checked against it