Secondary Prevention Implantable Cardioverter-Defibrillator for Cardiac Arrest Survivors on Hemodialysis in Japan - Nationwide Claims-Based Analysis

Q: How does ICD use differ between hemodialysis (HD) and non-HD cardiac arrest survivors?

ICD implantation was significantly lower in HD patients (27%) than in non-HD patients (44%) among cardiac arrest survivors with ventricular arrhythmias.

Q: What factors were associated with ICD implantation decisions in the multivariable analysis?

HD treatment was an independent negative predictor of ICD implantation (odds ratio 0.42, 95% confidence interval 0.37–0.47).

Q: How did subcutaneous-ICD use change over time among HD patients?

Subcutaneous-ICD use among HD patients increased significantly from 13% to 32% during 2016–2019 (P<0.001 for trend).

Q: Were there major differences in ICD implantation patterns across institutions or regions?

Among HD patients, ICD implantation rates were consistent across institutional characteristics and geographical regions.

Sep 30, 2026

Uploaded by Margaret

Nationwide JROAD-DPC claims data (2012–2020) were used to evaluate secondary prevention implantable cardioverter-defibrillator (ICD) implantation among cardiac arrest survivors with ventricular arrhythmias and no prior ICD, focusing on practice patterns in Japanese hemodialysis (HD) patients. Among 17,653 survivors, ICDs were used in 27% of HD patients versus 44% of non-HD patients. Multivariable analysis identified HD treatment as an independent negative predictor (odds ratio 0.42). Subcutaneous-ICD use increased from 13% to 32% (2016–2019) while implantation rates were consistent across institutions and regions, supporting baseline evidence for care consensus.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Background

Clinical implementation gap in Japan

Methods and Results

Nationwide analysis design (JROAD-DPC, 2012–2020)

ICD implantation rates in HD vs non-HD patients

Predictors and device selection trends

Institutional and geographical variation

Conclusions

Baseline evidence and need for prospective studies

Circulation Reports ORIGINAL ARTICLE Circ Rep 2026; 8: 48–57 doi:10.1253/circrep.CR-25-0209 Arrhythmia/Electrophysiology | Secondary Prevention Implantable Cardioverter-Defibrillator for Cardiac Arrest Survivors on Hemodialysis in Japan
―A Nationwide Claims-Based Analysis― | | | --- | --- | | Kosuke Nakasuka, MD, PhD; Yomei Sakurai, MD; Yu Kawada, MD, PhD; Tatsuya Mizoguchi, MD, PhD; Masashi Yokoi, MD, PhD; Kento Mori, MD, PhD;
Tsuyoshi Ito, MD, PhD; Shuichi Kitada, MD, PhD;
Toshihiko Goto, MD, PhD; Yoshihiro Seo, MD, PhD, FJCS
Background: The clinical implementation of secondary prevention implantable cardioverter-defibrillator (ICD) implantation in hemodialysis (HD) patients in Japan remains poorly characterized. We sought to characterize practice patterns and factors associated with secondary prevention ICD implantation in HD patients surviving cardiac arrest due to ventricular arrhythmias.
Methods and Results: Using the nationwide JROAD-DPC database (2012–2020), we analyzed cardiac arrest survivors with ventricular arrhythmias and no prior ICD. We assessed patient factors associated with ICD implantation and analyzed temporal trends in device selection, institutional and geographical variations in utilization patterns among HD patients. Among 17,653 cardiac arrest survivors, 530 of 1,931 HD patients (27%) received ICDs, significantly lower than 6,870 of 15,722 non-HD patients (44%; P<0.001) . Multivariable analysis revealed that HD treatment was an independent negative predictor of ICD implantation (odds ratio 0.42, 95% confidence interval [CI] 0.37-0.47) . Subcutaneous-ICD use among HD patients increased significantly from 13% to 32% during 2016–2019 (P<0.001 for trend). Among HD patients, ICD implantation rates were consistent across institutional characteristics and geographical regions.
Conclusions: This nationwide analysis revealed significantly lower secondary prevention ICD use in HD patients compared to non-HD patients, with consistent implementation patterns across Japan’s healthcare system. These findings provide important baseline evidence for developing consensus regarding ICD therapy and underscore the need for future prospective studies to guide optimal ICD selection in this population.
Key Words: Cardiac arrest survivor; Hemodialysis; Implantable cardioverter-defibrillator; JROAD-DPC database; Secondary prevention of sudden cardiac death | | | T
he number of patients with endstage renal disease requiring chronic hemodialysis (HD) continues to rise in Japan, reaching approximately 340,000
patients as of 2018.1 HD patients have higher mortality rates than the non-HD population, primarily due to cardiovascular disease,2,3 which accounts for 40% of all deaths among the HD population.4 Of particular concern are lifethreatening ventricular arrhythmias, including ventricular tachycardia (VT) and ventricular fibrillation (VF), which
contribute to 28% of deaths among HD patients.4
Implantable cardioverter-defibrillators (ICDs) have demonstrated effectiveness in preventing sudden cardiac death,5–7 and guidelines recommend secondary prevention | ICD implantation for all cardiac arrest survivors with lethal arrhythmias, except those with reversible causes or limited life expectancy.7–9 However, the guidelines derive from trials that largely excluded HD patients, potentially limiting their applicability to this population with unique risk-benefit considerations.
HD patients are susceptible to ventricular arrhythmias triggered by multiple potentially reversible factors, including cardiac ischemia, electrolyte and acid-base imbalance, and autonomic dysfunction.4,10 Additionally, they face increased risks of extracardiac complications such as frailty, multimorbidity, bacteremia, and bleeding.4,11–13 These complexities may affect the decision-making process for | Received August 26, 2025; revised manuscript received August 27, 2025; accepted August 28, 2025; J-STAGE Advance Publicat

FAQs

How does ICD use differ between hemodialysis (HD) and non-HD cardiac arrest survivors?

ICD implantation was significantly lower in HD patients (27%) than in non-HD patients (44%) among cardiac arrest survivors with ventricular arrhythmias.

What factors were associated with ICD implantation decisions in the multivariable analysis?

HD treatment was an independent negative predictor of ICD implantation (odds ratio 0.42, 95% confidence interval 0.37–0.47).

How did subcutaneous-ICD use change over time among HD patients?

Subcutaneous-ICD use among HD patients increased significantly from 13% to 32% during 2016–2019 (P<0.001 for trend).

Were there major differences in ICD implantation patterns across institutions or regions?

Among HD patients, ICD implantation rates were consistent across institutional characteristics and geographical regions.

Sep 30, 2026

Uploaded by Margaret