Oops – Brand New Guidance Needs Rewrite

I have just returned from the European Society of Cardiology annual meeting. The meeting was attended by 32,000 delegates from all over the world, with a huge number from Europe. There were several notable events for patients and clinicians interested in heart failure treatment.

The most remarkable of the studies presented was the “DANISH” study. This enrolled 1116 patients in 5 hospitals from all across Denmark who had heart failure in the absence of narrowed heart arteries. Doctors have long suspected that patients with heart failure who do not have coronary disease are at lower risk of a sudden death than those whose heart pumping problem is due to disease in the blood vessels that supply the heart. Indeed, several studies in the past have demonstrated that patients with narrowed heart arteries benefit from the implantation of a defibrillator, which reduces the risk of a sudden death.

For the last 5 years or so the guidelines produced both by NICE and the European Society of Cardiology have suggested that patients both with and without coronary artery disease have a reduced risk of sudden death if a defibrillator is implanted. However, this very large new study has demonstrated no benefit from the use of a defibrillator in patients without coronary disease.

Which is all very interesting and useful, but a tad embarrassing for the ESC. Prior to the presentation and simultaneous publication of the study the ESC had produced new guidance for the management of heart failure which still suggested that defibrillators are useful for this group of patients. I feel an urgent rewrite coming on.

Disclaimer: There are some patients without coronary disease who are still at very high risk of sudden death. You should not base the decision to have or not to have a defibrillator on this study alone and you should talk to your doctor before making any decision.

The full study can be found here:

http://www.nejm.org/doi/full/10.1056/NEJMoa1608029#t=article