Evaluation of the relationship between attachment styles and childhood traumatic experiences in patients with psoriasis

Primary prevention ICD is indicated in patients with EF ≤35% and NYHA class II-III heart failure despite at least 3 months of optimal medical therapy. However, the studies that form the basis of this recommendation belong to more than 20 years ago. These studies may not reflect the characteristics and treatment of current heart failure patients. Therefore, the effect of ICD for primary prevention on prognosis may be changed. Recent studies have called into question the effectiveness of the ICD. The aim of our study is to retrospectively evaluate the patients who had ICD for primary prevention implanted in our clinic. The primary outcomes of all-cause death and sudden death were compared in patients who underwent ICD for primary prevention at Dokuz Eylul University Hospital between 01.01.2015 and 01.03.2020 and patients with ICD indication but who did not accept this treatment. 228 patients who had ICD for primary prevention implanted due to heart failure and 150 patients who refused the treatment were compared. Of the 228 patients who had ICD for primary prevention implanted, 175 (76.8%) were male. The mean age of the patients was 65.63±11.94 years. The mean follow-up period of the patients was 39.45±18.89 months. The hospital stay for the procedure was 5.49±3.99 days. The mean left ventricular ejection fraction of the patients was found to be 24.30±6.19%. Of the ICD's implanted for primary prophylaxis, 92 (40.4%) were VVI ICD, 40 (17.5%) DDD ICD, 96 (42.1%) CRT ICD. Procedural complications developed in 36 (15.8%) of 228 patients. When these complications were analyzed according to the gender of the patients, complications developed in 21 (12%) of 175 male patients and 15 (28.3%) of 53 female patients. (p:0.004) When the ICD implanted group and the control group were compared in terms of mortality, 67 (29.4%) of 228 patients in the ICD arm and 39 (26%) of 150 patients in the control group died due to all causes. (p:0.473) When the ICD implanted group and the control group were compared in terms of sudden death, it was observed that 2 patients in the ICD arm and 8 patients in the control group experienced sudden death. (p:0.017) Age, left ventricular ejection fraction, BNP value, and hospitalization due to decompensation were found to be independent predictors of all-cause mortality by multiple logistic regression method. It was observed that all couse mortality was 3.4 times higher in patients who were hospitalized with decompensated heart failure before the procedure. In the ICD implanted group, the all-cause mortality of patients with a BNP value above 508.5, a LVEF value below 24.5%, and a age greater than 68.5 was 25 times higher than in other patients. (Wald:9.938 OR(95% Cl):0.039(0.005-0.293) p:0.002) It was seen that the presence of coronary artery disease was not an independent risk factor. Our patient population and our findings are compatible with current life data. We think that the recommendations for ICD for primary prevention implantation in the guidelines may regress with current treatment options. With the increase in the population unresponsive to the device, it will be important to determine which v patient population will benefit from the device in the future. We think that our study will contribute to the literature on this subject. Our study is one of the studies with the largest patient population, with a mean follow-up of 39 months, in which we shared our experience ofICDimplantation for primary prevention with two different ICD devices by different operators, a single-center, contain control group and determine mortality predictors.