Heart failure & cardiomyopathiesSecondary analysis
New York Heart Association Functional Class and Implantable Cardioverter-Defibrillator in Non-Ischaemic Heart Failure with Reduced Ejection Fraction: Extended Follow-Up of the DANISH Trial
- Secondary analysis of the DANISH randomised trial
- extended follow-up
- subgroup analysis by New York Heart Association (NYHA) class
Authors' conclusion
In patients with non-ischaemic HFrEF, ICD implantation, compared with usual care, did not reduce the overall mortality rate, but it did reduce sudden cardiovascular death, regardless of baseline NYHA class.
Study context
- Population
- Patients with non-ischaemic heart failure with reduced ejection fraction (HFrEF)
- Participants
- 1,116 patients
- Comparison
- Implantable cardioverter-defibrillator (ICD) implantation vs usual care, by NYHA class
- Primary endpoint
- All-cause mortality
- Follow-up
- Median 9.5 years
Primary result
As reported in the abstract
All-cause mortality, by NYHA class
ICD vs Usual careHR
all participants
0.89(95% CI 0.74–1.08)
NYHA class II
0.85(CI 0.64–1.13)
NYHA class III/IV
0.89(CI 0.69–1.14)
Further findings
| Outcome | Values | HR | |
|---|---|---|---|
| CV death, by NYHA class — ICD vs Usual care · all participants | 0.87 (95% CI 0.70–1.09) | ||
| CV death, by NYHA class — ICD vs Usual care · NYHA class II | 0.78 (CI 0.54–1.12) | ||
| CV death, by NYHA class — ICD vs Usual care · NYHA class III/IV | 0.89 (CI 0.67–1.19) | ||
| Sudden CV death, by NYHA class — ICD vs Usual care · all participants | 0.60 (95% CI 0.40–0.92) | ||
| Sudden CV death, by NYHA class — ICD vs Usual care · NYHA class II | 0.73 (CI 0.40–1.36) | ||
| Sudden CV death, by NYHA class — ICD vs Usual care · NYHA class III/IV | 0.52 (CI 0.29–0.94) | ||
| NYHA class III/IV vs II (prognosis) — NYHA III/IV vs NYHA II · all-cause mortality | 1.52 (95% CI 1.20–1.93) | ||
| NYHA class III/IV vs II (prognosis) — NYHA III/IV vs NYHA II · CV death | 1.95 (CI 1.47–2.60) | ||
| 0.20.5125Hazard ratio (log scale) |
| Outcome | Values | Estimate |
|---|---|---|
| Baseline NYHA class distribution | NYHA II 53.5% · NYHA III 45.3% · NYHA IV 1.3% |
- CV death, by NYHA class: interaction P = 0.58
- Sudden CV death, by NYHA class: interaction P = 0.39
Original publication
New York Heart Association Functional Class and Implantable Cardioverter-Defibrillator in Non-Ischaemic Heart Failure with Reduced Ejection Fraction: Extended Follow-Up of the DANISH Trial. Eur J Heart Fail. Published 11 May 2024. doi:10.1002/ejhf.3239
Summarised from the published abstract; every number is checked against it