AI Article Synopsis
- Diabetes significantly increases the all-cause and cardiac mortality rates in patients with implantable cardioverter defibrillators (ICDs), particularly among those receiving secondary prevention.
- A comprehensive analysis of 36 studies involving over 162,780 ICD recipients found that diabetic patients had higher mortality risk compared to nondiabetic patients, with a hazard ratio (HR) of 1.45 for all-cause mortality.
- Despite the higher mortality rates, diabetes does not significantly affect the risks associated with ICD therapies, suggesting that the increased mortality may not be linked to arrhythmias, and indicating limited survival benefits from ICD treatment for diabetic patients.
Article Abstract
Background: The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy.
Methods: We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs.
Results: Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36-1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56-2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35-2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39-0.79).
Conclusion: Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9338523 | PMC |
| http://dx.doi.org/10.1186/s12933-022-01580-y | DOI Listing |
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