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Clinical Articles, News & Views

Trial shows variation in benefits from ICD and amiodarone

A subgroup of SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) patients were harmed by amiodarone therapy and did not benefit from implantable cardioverter defibrillator (ICD) therapy, according to a study published recently in the Journal of the American College of Cardiology.1

In the SCD-HeFT trial, prespecified subgroup analysis showed that patients with New York Heart Association (NYHA) Class III symptoms did not benefit from ICD therapy and appeared to be harmed by amiodarone, while NYHA Class II patients obtained significant survival benefit from ICD. The authors postulated that a more objective measure of functional capacity, such as six-minute walk (SMW) distance, might provide a better tool for selecting these preventive therapies.

A SMW test was performed prior to randomisation in 2,397 patients. Median follow-up was 45.5 months. All-cause mortality was the primary endpoint, with cause-specific mortality (heart failure, arrhythmic) examined in secondary analyses.

The hazard ratios (95% CI) for ICD therapy compared to placebo were estimated within tertiles of baseline SMW distance: 0.42 (0.26, 0.66) for SMW distance >386m (top tertile), 0.57 (0.39, 0.83) for SMW distance 288–386 m (middle tertile), and 1.02 (0.75, 1.39) for SMW distance <288m (bottom tertile). The corresponding hazard ratios for amiodarone compared to placebo were 0.68 (0.46, 1.02) for the top, 0.86 (0.61, 1.21) middle, and 1.56 (1.17, 2.09) bottom tertile. SMW distance was inversely related to heart failure-related mortality but not to arrhythmic mortality. ICD therapy reduced arrhythmic mortality in the top two tertiles of SMW but had no effect on heart failure mortality.

References

1. Fishbein DP, Hellkamp AS, Mark DB, et al. Use of the six-minute walk distance to identify variations in treatment benefits from ICD and amiodarone: results from the sudden cardiac death in heart failure trial (SCD-HeFT). J Am Coll Cardiol 2014. http://dx.doi.org/10.1016/j.jacc.2014.02.602

Published on: April 30, 2014

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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