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. 2025 Jan 7;41(1):e13213.
doi: 10.1002/joa3.13213. eCollection 2025 Feb.

A novel prediction model for survival in individual patients with cardiac resynchronization therapy with a defibrillator: Analysis of the new Japan cardiac device treatment registry database

Hisashi Yokoshiki  1 , Akihiko Shimizu  2 , Takeshi Mitsuhashi  3 , Kohei Ishibashi  4 , Tomoyuki Kabutoya  5 , Yasuhiro Yoshiga  6 , Yusuke Kondo  7 , Taro Temma  8 , Masahiko Takagi  9 , Hiroshi Tada  10 ; Members of the Implantable Cardioverter‐Defibrillator (ICD) Committee of the Japanese Heart Rhythm Society
Affiliations

A novel prediction model for survival in individual patients with cardiac resynchronization therapy with a defibrillator: Analysis of the new Japan cardiac device treatment registry database

Hisashi Yokoshiki et al. J Arrhythm. .

Abstract

Background: Accurate prediction for survival in individualized patients with cardiac resynchronization therapy with a defibrillator (CRT-D) is difficult.

Methods: We analyzed the New Japan cardiac device treatment registry (JCDTR) database to develop a survival prediction model for CRT-D recipients.

Results: Four hundred and eighty-two CRT-D recipients, at the implantation year 2018-2021, with a QRS width ≥120 ms and left ventricular ejection fraction (LVEF) ≤35% at baseline, were analyzed. During an average follow-up of 21 ± 10 months, death occurred in 66 of 482 CRT-D patients (14%). A prediction model estimating annual survival probability was developed using Cox regression with internal validation. With seven explanation predictors (age >75 years, serum creatinine >1.4 mg/dL, blood hemoglobin <12 g/dL, heart rate ≥90/min, LVEF, prior NSVT, and QRS width <150 ms), the model distinguished patients with and without all-cause death, with an optimism-corrected C-statistics of 0.766, 0.764, and 0.768, and calibration slope of 1.01, 1.00, and 1.00 at 1 year, 2 years, and 3 years. Additionally, we have devised the calculator of survival probability for individual CRT-D recipients.

Conclusions: Using routine available variables, we have developed a survival prediction model for individual CRT-D recipients.

Keywords: cardiac resynchronization therapy with a defibrillator (CRT‐D); prediction model; survival probability; systolic heart failure; the new Japan cardiac device treatment registry database (new JCDTR).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Cumulative survival free from all‐cause death in CRT‐D recipients of the New JCDTR. Cumulative survival probability is plotted with 95% confidence intervals (dotted lines).
FIGURE 2
FIGURE 2
The model discrimination and calibration performance. (A) Time‐dependent receiver operating characteristic (ROC) curve, (B) calibration plot at 3 years showing the agreement between predicted (x axis) and observed (y axis) risk of the all‐cause death.
FIGURE 3
FIGURE 3
Kaplan–Meier estimates of survival probability in CRT‐D recipients of the New JCDTR stratified by the risk groups, which are classified according to the prognostic index (PI). −0.5 to 1.0 group: −0.5 ≤ PI <1.0; 1.0–2.25 group: 1.0 ≤ PI <2.25; 2.25–3.5 group: 2.25 ≤ PI <3.5; 3.5–5.0 group: 3.5 ≤ PI <5.0.
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