J Korean Med Sci.  2020 Dec;35(46):e397. 10.3346/jkms.2020.35.e397.

Implantable Cardioverter-defibrillator Utilization and Its Outcomes in Korea: Data from Korean Acute Heart Failure Registry

  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 3Department of Internal Medicine, Heart Research Center, Chonnam National University, Gwangju, Korea
  • 4Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
  • 5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 6Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
  • 7Department of Internal Medicine, School of Medicine, Sungkyunkwan University, Seoul, Korea
  • 8Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
  • 9Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
  • 10Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea


There are sparse data on the utilization rate of implantable cardioverterdefibrillator (ICD) and its beneficial effects in Korean patients with heart failure with reduced left ventricular ejection fraction (LVEF).
Among 5,625 acute heart failure (AHF) patients from 10 tertiary university hospitals across Korea, 485 patients with reassessed LVEF ≤ 35% at least 3 months after the index admission were enrolled in this study. The ICD implantation during the follow-up was evaluated. Mortality was compared between patients with ICDs and age-, sex-, and follow-up duration matched control patients.
Among 485 patients potentially indicated for an ICD for primary prevention, only 56 patients (11.5%) underwent ICD implantation during the follow-up. Patients with ICD showed a significantly lower all-cause mortality compared with their matched control population: adjusted hazard ratio (HR) (95% confidence interval [CI]) = 0.39 (0.16–0.92), P = 0.032. The mortality rate was still lower in the ICD group after excluding patients with cardiac resynchronization therapy (adjusted HR [95% CI] = 0.09 [0.01–0.63], P = 0.015). According to the subgroup analysis for ischemic heart failure, there was a significantly lower all-cause mortality in the ICD group than in the no-ICD group (HR [95% CI] = 0.20 [0.06– 0.72], P = 0.013), with a borderline statistical significance (interaction P = 0.069).
Follow-up data of this large, multicenter registry suggests a significant underutilization of ICD in Korean heart failure patients with reduced LVEF. Survival analysis implies that previously proven survival benefit of ICD in clinical trials could be extrapolated to Korean patients.


Implantable Cardioverter-defibrillator; Heart Failure
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