A Cochrane review [Abstract] 1 included 6 studies with a total of 3 128 subjects. The use of ICD plus optimal medical therapy versus optimal medical therapy alone decreased the risk of all-cause mortality (HR 0.78, 95% CI 0.66 to 0.92; 6 studies, n=3 128; number needed to treat for an additional beneficial outcome, NNTB=24) and sudden cardiac deaths (HR 0.45, 95% CI 0.29 to 0.70; 3 studies, n=1 677; NNTB=25). The observed decrease in cardiovascular mortality was not statistically significant (RR 0.75, 95% CI 0.46 to 1.21; 4 studies, n=1 781). ICDs probably increased adverse events (possibility of both plausible harm and benefit), but likely had little or no effect on non-cardiovascular mortality (RR 1.17, 95% CI 0.81 to 1.68; 4 studies, n=1 781). Using ICD therapy probably had little or no effect on quality of life, however shocks from the device cause a deterioration in quality of life.
The test for subgroup effect was only statistically significant for age. ICD, when added to optimal medical therapy, decreased the rate of death from any cause in patients younger than 65 years of age (HR 0.51, 95% CI 0.29 to 0.91; 1 study, n=348; NNTB = 10), but had little or no effect on patients 65 years of age or older (HR 0.98, 95% CI 0.73 to 1.31; 1 study, n=768).
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