2
|
Elming MB, Nielsen JC, Haarbo J, Videbæk L, Korup E, Signorovitch J, Olesen LL, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S, Køber L, Thune JJ. Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients With Nonischemic Systolic Heart Failure. Circulation 2017; 136:1772-1780. [PMID: 28877914 DOI: 10.1161/circulationaha.117.028829] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/19/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The DANISH study (Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter Defibrillators] in Patients With Non-Ischemic Systolic Heart Failure on Mortality) did not demonstrate an overall effect on all-cause mortality with ICD implantation. However, the prespecified subgroup analysis suggested a possible age-dependent association between ICD implantation and mortality with survival benefit seen only in the youngest patients. The nature of this relationship between age and outcome of a primary prevention ICD in patients with nonischemic systolic heart failure warrants further investigation. METHODS All 1116 patients from the DANISH study were included in this prespecified subgroup analysis. We assessed the relationship between ICD implantation and mortality by age, and an optimal age cutoff was estimated nonparametrically with selection impact curves. Modes of death were divided into sudden cardiac death and nonsudden death and compared between patients younger and older than this age cutoff with the use of χ2 analysis. RESULTS Median age of the study population was 63 years (range, 21-84 years). There was a linearly decreasing relationship between ICD and mortality with age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.003-1.06; P=0.03). An optimal age cutoff for ICD implantation was present at ≤70 years. There was an association between reduced all-cause mortality and ICD in patients ≤70 years of age (HR, 0.70; 95% CI, 0.51-0.96; P=0.03) but not in patients >70 years of age (HR, 1.05; 95% CI, 0.68-1.62; P=0.84). For patients ≤70 years old, the sudden cardiac death rate was 1.8 (95% CI, 1.3-2.5) and nonsudden death rate was 2.7 (95% CI, 2.1-3.5) events per 100 patient-years, whereas for patients >70 years old, the sudden cardiac death rate was 1.6 (95% CI, 0.8-3.2) and nonsudden death rate was 5.4 (95% CI, 3.7-7.8) events per 100 patient-years. This difference in modes of death between the 2 age groups was statistically significant (P=0.01). CONCLUSIONS In patients with systolic heart failure not caused by ischemic heart disease, the association between the ICD and survival decreased linearly with increasing age. In this study population, an age cutoff for ICD implantation at ≤70 years yielded the highest survival for the population as a whole. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945.
Collapse
Affiliation(s)
- Marie Bayer Elming
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.).
| | - Jens C Nielsen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jens Haarbo
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Lars Videbæk
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Eva Korup
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - James Signorovitch
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Line Lisbeth Olesen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Per Hildebrandt
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Flemming H Steffensen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Niels E Bruun
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Hans Eiskjær
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Axel Brandes
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Anna M Thøgersen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Finn Gustafsson
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Kenneth Egstrup
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Regitze Videbæk
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Christian Hassager
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jesper Hastrup Svendsen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Dan E Høfsten
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Christian Torp-Pedersen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Steen Pehrson
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Lars Køber
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jens Jakob Thune
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| |
Collapse
|
3
|
Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, Jensen G, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. N Engl J Med 2016; 375:1221-30. [PMID: 27571011 DOI: 10.1056/nejmoa1608029] [Citation(s) in RCA: 1148] [Impact Index Per Article: 143.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT). METHODS In a randomized, controlled trial, 556 patients with symptomatic systolic heart failure (left ventricular ejection fraction, ≤35%) not caused by coronary artery disease were assigned to receive an ICD, and 560 patients were assigned to receive usual clinical care (control group). In both groups, 58% of the patients received CRT. The primary outcome of the trial was death from any cause. The secondary outcomes were sudden cardiac death and cardiovascular death. RESULTS After a median follow-up period of 67.6 months, the primary outcome had occurred in 120 patients (21.6%) in the ICD group and in 131 patients (23.4%) in the control group (hazard ratio, 0.87; 95% confidence interval [CI], 0.68 to 1.12; P=0.28). Sudden cardiac death occurred in 24 patients (4.3%) in the ICD group and in 46 patients (8.2%) in the control group (hazard ratio, 0.50; 95% CI, 0.31 to 0.82; P=0.005). Device infection occurred in 27 patients (4.9%) in the ICD group and in 20 patients (3.6%) in the control group (P=0.29). CONCLUSIONS In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic and others; DANISH ClinicalTrials.gov number, NCT00542945 .).
Collapse
Affiliation(s)
- Lars Køber
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Jens J Thune
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Jens C Nielsen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Jens Haarbo
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Lars Videbæk
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Eva Korup
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Gunnar Jensen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Per Hildebrandt
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Flemming H Steffensen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Niels E Bruun
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Hans Eiskjær
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Axel Brandes
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Anna M Thøgersen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Finn Gustafsson
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Kenneth Egstrup
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Regitze Videbæk
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Christian Hassager
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Jesper H Svendsen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Dan E Høfsten
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Christian Torp-Pedersen
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| | - Steen Pehrson
- From the Department of Cardiology, Rigshospitalet (L.K., J.J.T., F.G., R.V., C.H., J.H.S., D.E.H., S.P.), and the Department of Cardiology, Bispebjerg Hospital (J.J.T.), University of Copenhagen, Copenhagen; the Department of Cardiology, Aarhus University Hospital, Aarhus (J.C.N., H.E.); the Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup (J.H., N.E.B.); the Department of Cardiology, Odense University Hospital, Odense (L.V., A.B.); the Department of Cardiology, Aalborg University Hospital (E.K., A.M.T., C.T.-P.), and the Clinical Institute, Aalborg University (N.E.B.), Aalborg; the Department of Cardiology, Zealand University Hospital, Roskilde (G.J.); Frederiksberg Heart Clinic, Frederiksberg (P.H.); the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S.); and the Department of Cardiology, Odense University Hospital, Svendborg (K.E.) - all in Denmark
| |
Collapse
|