Lower Observed Versus Expected (Based on U.S. Age and Gender Specific Rates) Survival in Patients Treated for Near-Fatal Ventricular Arrhythmias

Implantable cardioverter defibrillators (ICDs) have improved survival for patients with ventricular fibrillation (VF) or sustained vertricular tachycardia (VT). However, the survival of these patients compared to the general population has not been assessed. Observed survival rates for patients randomized to either antiarrhythmic drug therapy (mainly amiodarone) arm or ICD arm were compared to expected rates, calculated using age and sex-specific survival rates derived from the 1989-1991 US population life tables and applied to the age and sex distribution of patients in each arm. Consistent with the results of the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial, patients randomized to receive ICDs experienced significantly higher survival than those in the drug arm; however, both groups experienced significantly lower survival than expected using age and gender matched U.S. survival rates. Within arms, the difference between the observed and expected rates increased over 3 years of follow-up from 7.7% to 15.3% for the ICD arm, and from 14.6% to 26.4% for the drug arm. These results quantify the improvements in survival that can be expected for VF or VT patients using drug or ICD therapies and underscore the need for continued research into methods for further improving the overall level of health of these patients.