CSP #592 - Efficacy and Safety of ICD Implantation in the Elderly
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 167
- 试验地点
- 10
- 主要终点
- Mortality
研究概览
简要总结
The overall aim of this trial is to study the safety and efficacy of ICD implantation as a primary prevention strategy of sudden cardiac death in patients 70 years and older. This study will assess the many competing factors involved with ICD implantation including 1) the impact on mortality, especially in the context of a declining rate of sudden death with advanced age, 2) the tolerability of the powerful therapeutic action of the device, and 3) the impact on quality of life.
详细描述
The overall aim of this trial is to study the safety and efficacy of ICD implantation as a primary prevention strategy of sudden cardiac death (SCD) in patients 70 years and older. In particular, this study is designed to determine the comparative effectiveness of ICD, in addition to optimal medical therapy (OMT), in reducing all-cause mortality, versus OMT alone; OMT includes standard intervention for chronic heart failure patients, i.e. lifestyle modification, disease management, adoption of healthy diet and exercise practices, etcetera. One particularly important secondary objective is to assess treatment efficacy under the conditions of high versus low co-morbidity burden.
Participants will be randomized (1:1 ratio) to ICD + OMT or OMT alone, and stratified by participating site and co-morbidity level (Charlson score <3 versus 3+). Acute treatment visits will occur as clinically indicated and per local convention; follow-up will occur 1-4 months post-randomization (all participants), and not sooner than 30 days - and not later than 120 days post-implantation (ICD arm); regular follow-up will occur at 6 month intervals post-randomization until study close (all participants). All follow-up will be conducted centrally. Neither the participant nor treating clinician will be masked to treatment.
Primary Objective:
The primary objective of this study is to determine if a primary prevention strategy with ICD implantation in addition to optimal medical therapy (OMT) is effective in reducing all-cause mortality compared to OMT alone in patients 70 years of age and older who are eligible for ICD therapy according to current Centers for Medicare & Medicaid Services (CMS) criteria.
Primary Hypothesis:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 70 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •70 years of age or older
- •Eligible for ICD implementation according to the CMS criteria for primary prevention by one of the following conditions:
- •Documented prior MI and a measured left ventricular ejection fraction (LVEF) <=30% (includes New York Heart Association [NYHA] class I, II, or III)
- •Coronary artery disease with a documented prior MI, a measured left ventricular ejection fraction <=35%, and inducible, sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) at electrophysiology (EP) study
- •Ischemic dilated cardiomyopathy (IDCM), documented prior MI, NYHA class II and III heart failure, and measured LVEF <=35%
- •Non-ischemic dilated cardiomyopathy (NIDCM) > 3 months, NYHA Class II and III heart failure, and measured LVEF <=35%
- •Stable condition on Optimal Medical Therapy
- •Able and willing to provide informed consent to participate in this study
排除标准
- •Enrolled in or planning to enroll in a conflicting trial
- •Receiving a bi-ventricular ICD device
- •New York Heart Association class IV heart failure
- •Cardiogenic shock or symptomatic hypotension while in stable baseline rhythm,
- •Coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) within the past 3 months
- •An MI within the past 40 days
- •Clinical symptoms or findings that would make them a candidate for coronary revascularization
- •Irreversible brain damage from pre-existing cerebral disease
- •Any disease other than cardiac disease (e.g. cancer, uremia, liver failure), associated with a likelihood of survival less than 1 year
- •Circumstance that would prevent completion of the trial and follow-up activities, including medical condition
结局指标
主要结局
Mortality
时间窗: Through study completion, starting from consent/baseline: average of 31 months.
All-cause mortality
次要结局
- Quality of Life - Minnesota Living With Heart Failure Questionnaire(Measured at 12-months post-randomization)
- All-cause Hospitalization(Through study completion, starting from consent/baseline: average of 31 months.)
- Sudden Cardiac Death(Through study completion, starting from consent/baseline: average of 31 months.)