Abstract
Current guidelines do not recommend implantable cardioverter-defibrillator (ICD) implantation in patients with a life expectancy of <1 year. Better methods are needed for identifying patients at high risk for early mortality despite ICD therapy. To develop and validate a risk prediction score to identify patients at high risk for death within 1 year despite ICD therapy. Detailed clinical data were collected on a large observational cohort of ICD patients from 3 tertiary care centers. One-third of the patients were randomly selected to form the prediction group (PG) from which a risk score was developed using logistic regression. This score was then applied to the remaining two-thirds of the cohort (validation group [VG]) to assess the risk score's predictive accuracy. The total cohort included 2717 ICD patients (mean age = 64.6 ± 14.5, male = 77.2%, primary prevention = 74.7%). A simple risk score incorporating peripheral arterial disease, age < 70 years, creatinine < 2.0 mg/dL, and ejection fraction ≤20% (PACE) accurately predicted 1-year mortality in the VG. Patients with a risk score of <3 had a >4-fold excess 1-year mortality compared with patients with a risk score of <3 (16.5% vs 3.5%; P <.0001). Risk reduction provided by ICD therapy in this cohort is not known given the lack of a control group. A simple risk score accurately predicts 1-year mortality in ICD patients, as patients with a PACE risk score of <3 are at high risk despite ICD therapy.
Original language | English (US) |
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Pages (from-to) | 42-46 |
Number of pages | 5 |
Journal | Heart rhythm |
Volume | 9 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2012 |
Keywords
- Implantable cardioverter-defibrillators
- Outcomes research
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)