Predictors and rates of mortality in implantable cardioverter defibrillator recipients in the central midwest
Choudhuri I, Turkel RS, Singh M, Shearer RL, Ahmad AR, Omery B, Jahangir A, Mortada ME, Sra J. PREDICTORS AND RATES OF MORTALITY IN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR RECIPIENTS IN THE CENTRAL MIDWEST. Journal of the American College of Cardiology. 2016; 67(13_S):865-865.
Background: Implantable cardioverter defibrillator (ICD) therapy is expensive, but cost effectiveness has been demonstrated over longterm follow-up. Short-term mortality negatively impacts cost-effectiveness and ICD therapy is contraindicated in patients with expected longevityrecipients.
Methods: Patients who underwent initial ICD implant from 2008-14 within the Aurora Health Care network (Wisconsin and northern Illinois) with at least 3 years of follow-up and/or suffered the primary endpoint of death were evaluated. Cox regression was used to determine hazard ratios (HR) for significant predictors identified through forward stepwise analysis.
Results: In our ICD population (n=1560), total mortality was 194 (12.9%) and 42 patients died within 1 year of ICD implant (2.8%, 21.6% of total mortality). Clinical characteristics at the time of initial ICD implant that emerged as predictors of mortality included bradycardic arrest (HR 9.06, p70 (HR=2.39, p100 not meeting left bundle branch block [BBB] or right BBB criteria; HR 1.90, p
Conclusions: A small but substantial percentage of central Midwestern ICD patients are at risk for 1-year mortality, and 1/5 of our total ICD mortality occurred within 1 year of implant. Several clinical characteristics at initial ICD implant predict mortality, including 1-year mortality, in our large cohort. Applying a priori knowledge of predictors of mortality, particularly 1-year mortality, may improve patient selection and cost-effectiveness of ICD therapy.