Older persons with diabetes receive fewer inappropriate ICD shocks: Results from the INTRINSIC RV trial

In patients with heart disease, diabetes and age predict adverse outcomes. It remains unclear whether persons with diabetes who have implantable cardioverter defibrillators (ICDs) have fewer appropriate and inappropriate ICD shocks. The objective of this study is to determine if persons with diabetes who have ICDs receive a similar amount of appropriate and inappropriate shocks compared to persons without diabetes. In a post hoc analysis of 1,528 patients enrolled in the INTRINSIC RV trial, all-cause mortality and ICD shocks between persons with and without diabetes, stratified by age, was compared. The relationship between shock and mortality was also assessed. Mortality 1 year after ICD implant was lower for persons without diabetes vs. persons with diabetes (3.5% vs. 7.9%, p < 0.001). Young and old persons with diabetes received a similar number of total and appropriate ICD shocks. However, older persons with diabetes were less likely to receive inappropriate ICD shocks vs. older persons without diabetes (1.9% vs. 6.9%, p < 0.01). ICD shocks were not temporally related to mortality regardless of diabetes status. In the INTRINSIC RV trial, persons with diabetes and older persons without diabetes undergoing ICD implant were at a higher risk of death. Older persons with diabetes received less inappropriate shocks and still had a similar amount of appropriate shocks compared to persons without diabetes of similar age.