Temporal trends in population characteristics and type of device among primary prevention implantable cardioverter defibrillator recipients: The DAI-PP programme.

Abstract

Background: Patient characteristics, technology and clinical practice surrounding primary prevention implantable cardioverter defibrillators have evolved continuously over time.

Aim: To explore the temporal changes in patient characteristics, pharmacological therapy and device types among implantable cardioverter defibrillator recipients implanted for the primary prevention of sudden cardiac death over the last two decades in France.

Methods: Characteristics of participants and type of device from the retrospective DAI-PP Pilot Study (2002-2012) were compared with those from the ongoing prospective DAI-PP Consortium (2018 onwards).

Results: This study included 9588 participants overall (DAI-PP Pilot Study, n=5539; DAI-PP Consortium, n=4049). Compared with the DAI-PP Pilot Study, the DAI-PP Consortium subjects were older at implantation (62.5 vs 65.2 years; P=0.001) and had a higher proportion of women (15.1% vs 20.6%; P<0.001), a similar proportion of ischaemic heart disease (60.2% vs 60.2%; P=0.98), a higher left ventricular ejection fraction (27±7% vs 30±8%; P<0.001) and more patients with narrow QRS complexes (30.5% vs 46.0%; P<0.001). The proportion of patients treated with heart failure drugs increased significantly (70.1% vs 83.1%; P<0.001), whereas the use of amiodarone became much less frequent (22.7% vs 14.7%; P<0.001). Finally, the proportions of cardiac resynchronization therapy defibrillators (53.8% vs 46.4%; P<0.001) and dual-chamber defibrillators (23.3% vs 17.3%; P<0.001) decreased, whereas subcutaneous implantable cardioverter defibrillators now account for a sizeable proportion of implants (14.6%).

Conclusions: Over a 20-year period, the primary prevention implantable cardioverter defibrillator population has evolved significantly, with an older age and a higher proportion of women. The type of device has changed, with fewer cardiac resynchronization therapy defibrillators and more subcutaneous implantable cardioverter defibrillators.