Heart failure & cardiomyopathies
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
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 New York Heart Association (NYHA) class
- Primary endpoint
- All-cause mortality
- Follow-up
- Median 9.5 years
Methodological detailsextended follow-up, subgroup analysis by NYHA class
- Extended follow-up
- Subgroup analysis by NYHA class
Primary result
As reported in the abstract
All-cause mortality, by NYHA class
ICD vs Usual careHazard ratio (95% CI)
All participants
0.89(0.74–1.08)
NYHA class II
0.85(0.64–1.13)
NYHA class III/IV
0.89(0.69–1.14)
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| CV death, by NYHA classICDvs Usual careAll participants | 0.87 (0.70–1.09) | |
| CV death, by NYHA classICDvs Usual careNYHA class II | 0.78 (0.54–1.12) | |
| CV death, by NYHA classICDvs Usual careNYHA class III/IV | 0.89 (0.67–1.19) | |
| Sudden CV death, by NYHA classICDvs Usual careAll participants | 0.60 (0.40–0.92) | |
| Sudden CV death, by NYHA classICDvs Usual careNYHA class II | 0.73 (0.40–1.36) | |
| Sudden CV death, by NYHA classICDvs Usual careNYHA class III/IV | 0.52 (0.29–0.94) | |
| NYHA class III/IV vs II (prognosis)NYHA III/IVvs NYHA IIAll-cause mortality | 1.52 (1.20–1.93) | |
| NYHA class III/IV vs II (prognosis)NYHA III/IVvs NYHA IICV death | 1.95 (1.47–2.60) | |
| 0.20.5125Hazard ratio (log scale) |
Baseline NYHA class distribution
- 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.
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