Abstract: SA-OR42
Long-Term Outcomes of Subcutaneous vs. Transvenous Implantable Cardioverter Defibrillator Use among Dialysis Patients
Session Information
- Dialysis Vascular Access: Research Advances
October 26, 2024 | Location: Room 8, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Pun, Patrick H., Duke Clinical Research Institute, Durham, North Carolina, United States
- Qin, Li, Yale New Haven Health System, New Haven, Connecticut, United States
- Minges, Karl, Yale New Haven Health System, New Haven, Connecticut, United States
- Al-Khatib, Sana, Duke Clinical Research Institute, Durham, North Carolina, United States
- Friedman, Daniel J., Duke Clinical Research Institute, Durham, North Carolina, United States
Background
Despite high risks of sudden cardiac death among dialysis patients, implantable cardioverter defibrillators(ICDs) have not been shown to improve mortality and are associated with high complication risks. Compared to transvenous(TV-)ICDs, subcutaneous(S-)ICDs may reduce the risk of infection, device- and vascular complications due to absence of intravascular leads. However, the long-term risks and benefits of S-ICD vs. TV-ICD in this population are unknown.
Methods
Retrospective analysis of ICD implants in Fee-For-Service Medicare beneficiary dialysis patients from 2012-2019 in the National Cardiovascular Data Registry ICD Registry. Outcomes were ascertained from Medicare claims data. We compared ICD and dialysis access complications, hospital admissions, and survival outcomes between eligible S-ICD and single chamber TV-ICD recipients using stabilized inverse probability of treatment weighting.
Results
535 dialysis patients with S-ICDs and 842 with TV-ICDs met inclusion criteria. Median follow-up was 1.9 years. S-ICD recipients were younger, more likely to be Black, and had higher burdens of cardiac disease and prior dialysis access procedures. After propensity weighting, there was no difference in the risk of death (HR 1.12, 95%CI 0.96-1.30), device reoperation (HR 1.07, 95%CI 0.60-1.91), sepsis/bacteremia (HR 0.99, 95%CI 0.79-1.25) and hospital admission (HR 1.01, 95% CI 0.88-1.16) between ICD groups. Dialysis access interventions were more frequent among S-ICD recipients (8.4 vs 6.7% annually, p<0.01), but there was no risk difference after accounting for competing risks of death (HR 1.10, 95%CI 0.84-1.44).
Conclusion
In the largest longitudinal cohort of dialysis patients with S-ICD reported to date, compared to TV-ICD recipients, S-ICD was not associated with improved survival, device- and dialysis access-complication rates.
Funding
- Private Foundation Support