University of Oulu

Junttila, M. J., Pelli, A., Kenttä, T. V., Friede, T., Willems, R., Bergau, L., Malik, M., Vandenberk, B., Vos, M. A., Schmidt, G., Merkely, B., Lubinski, A., Svetlosak, M., Braunschweig, F., Harden, M., Zabel, M., Huikuri, H. V., & Sticherling, C. (2019). Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic Implantable Cardioverter Defibrillators. In Diabetes Care (Vol. 43, Issue 1, pp. 196–200). American Diabetes Association.

Appropriate shocks and mortality in patients with versus without diabetes with prophylactic implantable cardioverter defibrillators

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Author: Junttila, M. Juhani1; Pelli, Ari1; Kenttä, Tuomas V.1;
Organizations: 1Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
2Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
3German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
4Department of Cardiovascular Sciences, University of Leuven and University Hospitals Leuven, Leuven, Belgium
5Department of Cardiology and Pneumology, Heart Center, Division of Cardiology, University Medical Center Göttingen, Göttingen, Germany
6National Heart and Lung Institute, Imperial College, London, U.K.
7Medical Physiology, University Medical Center Utrecht, Utrecht, the Netherlands
8Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
9Semmelweis University Heart Center, Budapest, Hungary
10Medical University Lodz, Lodz, Poland
11Slovak Medical University and Institute of Cardiovascular Diseases, Bratislava, Slovakia
12Karolinska Institute, Stockholm, Sweden
13Division of Cardiology, University Hospital of Basel, Basel, Switzerland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: American Diabetes Association, 2020
Publish Date: 2021-11-11


Objective: Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in the retrospective EU-CERT-ICD registry.

Research design and methods and results: A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62–0.96], P = 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11–1.53], P = 0.001).

Conclusions: All-cause mortality is higher in patients with diabetes than in patients without diabetes with primary prophylactic ICDs. Subsequently, patients with diabetes have a lower incidence of appropriate ICD shocks, indicating that the excess mortality might not be caused primarily by ventricular tachyarrhythmias. These findings suggest a limitation of the potential of prophylactic ICD therapy to improve survival in patients with diabetes with impaired left ventricular function.

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Series: Diabetes care
ISSN: 0149-5992
ISSN-E: 1935-5548
ISSN-L: 0149-5992
Volume: 43
Issue: 1
Pages: 196 - 200
DOI: 10.2337/dc19-1014
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: The EU-CERT-ICD project is funded by the European Community’s 7th Framework Programme FP7/2007–2013 (grant agreement number 602299).
EU Grant Number: (602299) EU-CERT-ICD - Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in EUrope
Copyright information: © 2019 by the American Diabetes Association. Authors are permitted to submit the final, accepted version of their manuscript to their funding body or institution for inclusion in their funding body or institution's database, archive, or repository; on their personal website; and on scholarly collaboration networks that subscribe to STM’s “Voluntary Principles for Article Sharing on Scholarly Collaboration Networks.” These manuscripts may be made freely accessible to the public upon acceptance, provided that a link to the final article published in the ADA journal is included when available.