Imperial College London
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ProfessorJamilMayet

Faculty of Medicine, National Heart & Lung Institute

Professor of Cardiology
 
 
 
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Contact

 

+44 (0)20 7594 1006j.mayet

 
 
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Assistant

 

Miss Juliet Holmes +44 (0)20 7594 5735

 
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Location

 

NHLI offices,Sir Michael Uren HubWhite City Campus

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Summary

 

Publications

Citation

BibTex format

@article{Raphael:2015:eurheartj/ehv102,
author = {Raphael, CE and Finegold, JA and Barron, AJ and Whinnett, ZI and Mayet, J and Linde, C and Cleland, JGF and Levy, WC and Francis, DP},
doi = {eurheartj/ehv102},
journal = {European Heart Journal},
pages = {1676--1688},
title = {The effect of duration of follow-up and presence of competing risk on lifespan-gain from implantable cardioverter defibrillator therapy: who benefits the most?},
url = {http://dx.doi.org/10.1093/eurheartj/ehv102},
volume = {36},
year = {2015}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundIn at-risk patients with left ventricular dysfunction, implantable cardioverter defibrillators (ICDs) prolong life. Implantable cardioverter defibrillators are increasingly implanted for primary prevention and therefore into lower risk patients. Trial data have demonstrated the benefit of these devices but does not provide an estimate of potential lifespan-gain over longer time periods, e.g. a patient's lifespan.MethodsUsing data from landmark ICD trials, lifespan-gain was plotted against baseline annual mortality in the individual trials. Lifespan-gain was then extrapolated to a time-horizon of >20 years while adjusting for increasing ‘competing’ risk from ageing and non-sudden cardiac death (pump failure).ResultsAt 3 years, directly observed lifespan-gain was strongly dependent on baseline event rate (r = 0.94, P < 0.001). However, projecting beyond the duration of the trial, lifespan-gain increases rapidly and non-linearly with time. At 3 years, it averages 1.7 months, but by 10 years up to 9-fold more. Lifespan-gain over time horizons >20 years were greatest in lower risk patients (∼5 life-years for 5% baseline mortality, ∼2 life-years for 15% baseline mortality). Increased competing risks significantly reduce lifespan-gain from ICD implantation.ConclusionWhile high-risk patients may show the greatest short-term gain, the dramatic growth of lifespan-gain over time means that it is the lower risk patients, e.g. primary prevention ICD implantation, who gain the most life-years over their lifetime. Benefit is underestimated when only trial data are assessed as trials can only maintain randomization over limited periods. Lifespan-gain may be further increased through advances in ICD device programming.
AU  - Raphael,CE
AU  - Finegold,JA
AU  - Barron,AJ
AU  - Whinnett,ZI
AU  - Mayet,J
AU  - Linde,C
AU  - Cleland,JGF
AU  - Levy,WC
AU  - Francis,DP
DO  - eurheartj/ehv102
EP  - 1688
PY  - 2015///
SN  - 0195-668X
SP  - 1676
TI  - The effect of duration of follow-up and presence of competing risk on lifespan-gain from implantable cardioverter defibrillator therapy: who benefits the most?
T2  - European Heart Journal
UR  - http://dx.doi.org/10.1093/eurheartj/ehv102
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000358178100013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://academic.oup.com/eurheartj/article/36/26/1676/2293317
VL  - 36
ER  -
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