In:
Annals of Noninvasive Electrocardiology, Wiley, Vol. 18, No. 4 ( 2013-07), p. 379-388
Abstract:
Current guidelines consider the implantation of an implantable cardioverter defibrillator (ICD) a class III indication in patients with a life expectancy of 〈 1 year. An evaluation of concomitant noncardiac conditions may identify patients whom may not derive benefit with ICD therapy. We sought to evaluate the association of the Charlson comorbidity index (CCI) on the prediction of early mortality (EM), death 〈 1 year after ICD implant. Methods The study population consisted of patients (n = 1062) undergoing ICD implantation for the primary or secondary prevention of sudden cardiac death from 1997 to 2007. The predictive value of the CCI on the risk of EM and appropriate shock therapy for ventricular arrhythmias as compared to patients without EM after ICD implant was calculated using multivariable Cox proportional hazards and receiver operator analyses. Results Patients experiencing EM (n = 110) demonstrated higher CCI scores (mean 2.8 ± 1.3 vs 1.5 ± 1.2, P 〈 0.001) as compared to individuals without EM (n = 963). Among patients with a CCI of 0, 1, 2, 3, 4, and ≥5, the incidence of EM increased from 5% to 78%. The CCI was an independent predictor of EM (AHR 1.4 [95% CI 1.2–1.6], P 〈 0.001, per single score increase). Patients who experienced EM demonstrated a decreased incidence of appropriate ICD therapy when compared to patients without EM (AHR 0.4 [95% CI 0.2–0.7], P = 0.001). Conclusion Noncardiac conditions are commonly observed among patients undergoing ICD implantation. Guidelines must incorporate a comprehensive assessment of concomitant comorbidities to minimize the risk of EM and to maximize the survival benefit with ICD therapy.
Type of Medium:
Online Resource
ISSN:
1082-720X
,
1542-474X
Language:
English
Publisher:
Wiley
Publication Date:
2013
detail.hit.zdb_id:
2111515-1
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