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. 2017 May;22(3):e12414.
doi: 10.1111/anec.12414. Epub 2016 Nov 1.

Clinical risk profile score predicts all cause mortality but not implantable cardioverter defibrillator intervention rate in a large unselected cohort of patients with congestive heart failure

Johanna Sjöblom  1 , Rasmus Borgquist  2 , Fredrik Gadler  3 , Torbjörn Kalm  3 , Lina Ljung  4 , Mårten Rosenqvist  1 , Viveka Frykman  1 , Pyotr G Platonov  2
Affiliations

Clinical risk profile score predicts all cause mortality but not implantable cardioverter defibrillator intervention rate in a large unselected cohort of patients with congestive heart failure

Johanna Sjöblom et al. Ann Noninvasive Electrocardiol. 2017 May.

Abstract

Background: Primary prophylactic implantable cardioverter defibrillator (ICD) therapy is indicated for patients with reduced left ventricular ejection fraction (LVEF). We aimed to determine if preoperative clinical risk profiling can predict long-term benefit, and if clinical risk scores can be applied and improved in a patient cohort outside the clinical trial setting.

Methods: Using registry data, 789 patients with reduced LVEF who received ICDs for primary prevention during 2006-2011 were identified (age 64 ± 11 years, 82% men, 63% ischemic etiology, 52% cardiac resynchronization therapy with defibrillator). The patients were divided into three risk groups, based on the presence of baseline clinical risk factors (age >70, QRS duration >120 ms, New York Heart Association class III-IV, atrial fibrillation history, or creatinine >106 μmol/L). Endpoints were all-cause mortality and survival free of adequate ICD therapy.

Results: Mean follow-up was 39 ± 18 months. Annual mortality was 7.6%, and increased with risk group (p < .001). Rates of appropriate antitachycardia pacing and shock therapy were not statistically different between the groups, and ranged from 11%-16% and 6%-14%, respectively. By combining the previous risk score with data on diabetes, a better independent prediction of mortality was achieved; mortality rates then ranged from 11% (low-risk) to 46% (high-risk) (p < .0001).

Conclusions: Implantable cardioverter defibrillator therapies occur across the spectrum of comorbidities in a population with systolic heart failure. However, all-cause mortality is considerably higher in the group of patients with accumulated risk factors, and using the proposed scoring system can be helpful for the evaluation and risk stratification of the patient prior to making a decision for a primary prophylactic ICD implantation.

Keywords: heart failure; implanted cardioverter defibrillator; primary prevention; risk score; sudden cardiac death.

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Conflict of interest statement

The authors report no relationships that could be construed as a conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves stratified according to risk group: Low‐risk group (green), medium‐risk group (yellow), and high‐risk group (red). (a) shows cumulative survival. Low‐ versus medium‐risk group, p = .68; medium‐ versus high‐risk group, p < .0001. (b) shows survival free of implantable cardioverter defibrillator (ICD) therapy. Low‐ versus medium‐risk group, p = .70; medium‐ versus high‐risk group, p <.001
Figure 2
Figure 2
Kaplan–Meier curves for survival and survival free of implantable cardioverter defibrillator (ICD) therapy, using the diabetes‐adjusted risk score. Low‐risk group (green), medium‐risk group (yellow), and high‐risk group (red). (a) shows cumulative survival. Low‐ versus medium‐risk group, p < .0001. (b) shows survival free of ICD therapy. p <.0001 for all groups
See this image and copyright information in PMC

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