Evidence map›Paper›PMID 28888266›Full record

SynthesisAmerican heart journal2017

New York Heart Association class and the survival benefit from primary prevention implantable cardioverter defibrillators: A pooled analysis of 4 randomized controlled trials.

Daniel J Friedman, Sana M Al-Khatib, Emily P Zeitler, JooYoon Han, Gust H Bardy, Jeanne E Poole, J Thomas Bigger, Alfred E Buxton, Arthur J Moss, Kerry L Lee and 8 more

Abstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in American heart journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Efficacy and safety of ventricular tachycardia ablation versus antiarrhythmics in ischemic cardiomyopathy: a network meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Article
  3. Article
  4. Article
  5. The Utility of Baseline Characteristics and [Journal of clinical medicine · 2024
    Article
  6. Review
  7. Article
  8. Article
  9. Article
  10. Review
  11. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2020
    Article
  12. Review
  13. Article
  14. Observational
  15. Article
  16. Review
  17. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Daniel J FriedmanDuke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Sana M Al-KhatibDuke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Emily P ZeitlerDuke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC.
JooYoon HanUniversity of Washington, Seattle, WA.
Gust H BardyUniversity of Washington, Seattle, WA.
Jeanne E PooleUniversity of Washington, Seattle, WA.
J Thomas BiggerColumbia University, New York, NY.
Alfred E BuxtonBeth Israel Deaconess Medical Center, Boston, MA.
Arthur J MossUniversity of Rochester, Rochester, NY.
Kerry L LeeDuke Clinical Research Institute, Durham, NC.
Richard SteinmanColumbia University, New York, NY.
Paul DorianUniversity of Toronto, Toronto, Ontario, Canada.
Riccardo CappatoHumanitas University and Humanitas Clinical Research Center, Milan, Italy.
Alan H KadishFeinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL.
Peter J KudenchukUniversity of Washington, Seattle, WA.
Daniel B MarkDuke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Lurdes Y T InoueUniversity of Washington, Seattle, WA.
Gillian D SandersDuke Clinical Research Institute, Durham, NC. Electronic address: gillian.sanders@duke.edu.

Funding

Postdoctoral Training in Cardiovascular Clinical ResearchT32HL069749 · NHLBI · DUKE UNIVERSITY · PI MARK, DANIEL B · 2003 to 2023
$6.7M
Power of Bayesian Methods, RCTs, and Decision Models to Inform CRT UncertaintiesR01HL131754 · NHLBI · DUKE UNIVERSITY · PI SCHMIDLER, GILLIAN SANDERS · 2017 to 2020
$2.7M
Preventing Sudden Cardiac Death: Harnessing the Power of Decision Analysis, BayeR01HS018505 · AHRQ · DUKE UNIVERSITY · PI SCHMIDLER, GILLIAN SANDERS · 2009 to 2011
$1.5M
AHRQ HHS R01 HS018505NHLBI NIH HHS R01 HL131754NHLBI NIH HHS T32 HL069749
6 · The paper itself

Abstract

backgroundPrimary prevention implantable cardioverter defibrillator (ICD) reduce all-cause mortality by reducing sudden cardiac death. There are conflicting data regarding whether patients with more advanced heart failure derive ICD benefit owing to the competing risk of nonsudden death.

methodsWe performed a patient-level meta-analysis of New York Heart Association (NYHA) class II/III heart failure patients (left ventricular ejection fraction ≤35%) from 4 primary prevention ICD trials (MADIT-I, MADIT-II, DEFINITE, SCD-HeFT). Bayesian-Weibull survival regression models were used to assess the impact of NYHA class on the relationship between ICD use and mortality.

resultsOf the 2,763 patients who met study criteria, 68% (n=1,867) were NYHA II and 52% (n=1,435) were randomized to an ICD. In a multivariable model including all study patients, the ICD reduced mortality (hazard ratio [HR] 0.65, 95% posterior credibility interval [PCI]) 0.40-0.99). The interaction between NYHA class and the ICD on mortality was significant (posterior probability of no interaction=.036). In models including an interaction term for the NYHA class and ICD, the ICD reduced mortality among NYHA class II patients (HR 0.55, PCI 0.35-0.85), and the point estimate suggested reduced mortality in NYHA class III patients (HR 0.76, PCI 0.48-1.24), although this was not statistically significant.

conclusionsPrimary prevention ICDs reduce mortality in NYHA class II patients and trend toward reducing mortality in the heterogeneous group of NYHA class III patients. Improved risk stratification tools are required to guide patient selection and shared decision making among NYHA class III primary prevention ICD candidates.

Indexed as

CardiologyDeath, Sudden, CardiacDefibrillators, ImplantableRandomized Controlled Trials as TopicSocieties, MedicalGlobal HealthHeart FailureHumansNew YorkPrimary PreventionSurvival Rate

Identifiers

PMID28888266
PMCPMC5657554

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.