P182 Implantable cardioverter defibrillator in old age patients with cardiomyopathy : a meta-analysis and systematic review
Bibliographic record
Abstract
Abstract Introduction Implantable cardioverter defibrillator (AICD) showed benefit for primary prevention of death in cardiomyopathy, but still controversy in elderly. We performed a systematic review and meta analysis to the benefit of AICD for primary prevention of death in patients age ≥ 65 with cardiomyopathy according to 2017 ACC/AHA guideline for the Management Ventricular Arrhythmias and 2015 ESC guideline for Management of Ventricular Arrythmias. Method We comprehensively searched the databases of MEDLINE, EMBASE and SCOPUS from inception to October 2018. Included studies with prospective and retrospective cohort design. Studies those compared all-cause mortality in elderly patients who has been implanted with AICD versus none. Data of each studies were combined with random effects model, subgroup analysis for each types of studies were done. All the results were reported in hazard ration (HR) and 95% confidence intervals. Result Nine studies from March 2002 to October 2018 were included in meta-analysis (Five randomized controlled trial and Four cohort studies) involving 20,656 patients. AICD implantation showed benefit in reduction of all-cause mortality in patients older than 65 years.( pooled hazard ratio = 0.72, 95% confidence interval: 0.64 – 0.81, I2 = 56.3%),however pool hazard ratio from subgroup analysis with only randomized controlled trial did not demonstrate effectiveness of this intervention. (pooled hazard ratio 0.78, 95% confidence interval: 0.61 – 1, I2= 49.5%) Conclusion AICD could benefit in reduction of all-cause mortality in aged patients. However randomized controlled trial with larger population in this group is needed. Clinical characteristics of studies Author Year Study type Total population Age of participant (year) Type of cardiomyopathy NYHA FC Median follow up ( months) Outcome definition Quality assessment Bias for RCT Mezu 2011 Prospective cohort 485 ≥ 80 Ischemic and non-ischemic cardiomyopathy II - III 12 All-cause mortality Newcastle - ottawa : Fair Kober (DANISH) 2016 Randomize controlled trial 393 ≥ 68 Non ischemic cardiomyopathy II - III 67.6 All-cause mortality Performance bias Chan 2009 Prospective cohort 852 ≥ 65 Ischemic and non-ischemic cardiomyopathy N/A 34 ± 16 All-cause mortality Newcastle - ottawa : Fair Kadish (DEFINITE) 2004 Randomize controlled trial 157 ≥ 65 Non ischemic cardiomyopathy I - III 29 ± 14.4 All-cause mortality Performance bias Bristow (COMPANION) 2004 Randomize controlled trial 853 ≥ 65 Ischemic and non-ischemic cardiomyopathy III - IV 16.5 All-cause mortality Performance bias Moss ( MADIT II) 2002 Randomize controlled trial 436 ≥ 70 Ischemic cardiomyopathy I - III 20 All-cause mortality Performance bias Groeneveld 2008 Prospective cohort 14250 ≥ 65 Ischemic and non-ischemic cardiomyopathy I - IV 24 All-cause mortality Newcastle - ottawa : Fair Bardy ( SCD HEFT) 2005 Randomize controlled trial 578 ≥ 65 Ischemic and non-ischemic cardiomyopathy II - III 45.5 All-cause mortality Performance bias Pokorney 2015 Retrospective cohort 852 ≥ 65 Ischemic and non-ischemic cardiomyopathy IV 36 All-cause mortality Newcastle - ottawa : Fair Abstract P182 Figure. Forest plot of elderly with AICD vs none
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.020 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.038 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".