ArticleCirculation reports2026
Secondary Prevention Implantable Cardioverter-Defibrillator for Cardiac Arrest Survivors on Hemodialysis in Japan - A Nationwide Claims-Based Analysis.
Article in Circulation reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The clinical implementation of secondary prevention implantable cardioverter-defibrillator (ICD) implantation in hemodialysis (HD) patients in Japan remains poorly characterized. We sought to characterize practice patterns and factors associated with secondary prevention ICD implantation in HD patients surviving cardiac arrest due to ventricular arrhythmias. Methods and Results: Using the nationwide JROAD-DPC database (2012-2020), we analyzed cardiac arrest survivors with ventricular arrhythmias and no prior ICD. We assessed patient factors associated with ICD implantation and analyzed temporal trends in device selection, institutional and geographical variations in utilization patterns among HD patients. Among 17,653 cardiac arrest survivors, 530 of 1,931 HD patients (27%) received ICDs, significantly lower than 6,870 of 15,722 non-HD patients (44%; P<0.001). Multivariable analysis revealed that HD treatment was an independent negative predictor of ICD implantation (odds ratio 0.42, 95% confidence interval [CI] 0.37-0.47). Subcutaneous-ICD use among HD patients increased significantly from 13% to 32% during 2016-2019 (P<0.001 for trend). Among HD patients, ICD implantation rates were consistent across institutional characteristics and geographical regions. Conclusions: This nationwide analysis revealed significantly lower secondary prevention ICD use in HD patients compared to non-HD patients, with consistent implementation patterns across Japan's healthcare system. These findings provide important baseline evidence for developing consensus regarding ICD therapy and underscore the need for future prospective studies to guide optimal ICD selection in this population.
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