Clinical Question: Do implantable d...

Clinical Question: Do implantable defibrillators decrease mortality in patients with nonischemic cardiomyopathy?

Setting: Various (meta-analysis)

subject of attention Design: Meta-analysis (randomized controlled trials)

Synopsis: Investigators thoroughly searched multiple databases using evidence-based sources including MEDLINE, EMBASE, and the Cochrane Central Register of Controll Trials. Inclusion criteria identified single prospective randomized controlled trials of implantable defibrillators versus medical therapy in patients with nonischemic cardiomyopathy. The trials reported all-cause mortality. From an initial 675 articles of potential relevance, eight met the inclusion criteria (with a total of 2146 patients). Of these, five were primary prevention trials enrolling 1854 patients with nonischemic cardiomyopathy. The authors did not state specifically whether the individual studies were evaluated independently by dint of more than one person.

Overall, mortality was reduc significantly among patients randomized to an implantable defibrillator versus medical therapy (relative risk = 069; 95 percent confidence interval, 055 to 087) The findings from the various studies were similar (homogeneous) and there was no evidence of significant publication bias. Implantable defibrillators did not decrease mortality following a myocardial infarction (Hohnloser SH et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J M December 9 2004;351:2481-8)

Bottom Line: In addition to standard medical therapy, implantable defibrillators further attenuate mortality in selected patients with nonischemic cardiomyopathy. (Level of Evidence: 1a-)

inquiry Reference: Desai AS, et al. Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controll trials. JAMA December 15 2004;292:2874-9

Used with permission from Slawson D Implantable defibrillators beneficial for nonischemic cardiomyopathy. Accessed online January 25 2005 at: http://www.InfoPOEMs.com.

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