One‐year mortality after implantable cardioverter‐defibrillator placement within the Veterans Affairs Health System

Abstract

Aims Implantable cardioverter‐defibrillator (ICD) therapy reduces mortality in patients with heart failure and current guidelines advise implantation of ICDs in patients with a life expectancy of >1 year. We examined trends in all‐cause mortality in patients who underwent primary or secondary prevention ICD placement in the Veterans Affairs (VA) Health System. Methods and results US veterans receiving a new ICD placement for primary or secondary prevention of sudden cardiac death between January 2007 and January 2015, who had heart failure with reduced ejection fraction (HFrEF) were included in the analysis. We assessed all‐cause mortality 1 year post‐ICD implantation. ICD implantation and HFrEF diagnosis were established with associated ICD‐9 codes. The VA death registry was utilized to identify mortality rates following ICD placement. Results were subsequently age‐stratified. There were 17 901 veterans with HFrEF with ICD placement nationwide. There was no statistically significant difference in 1‐year mortality from 2007 (13.1%) to 2014 (13.4%, P > 0.05). There was a significant increase in 1‐year mortality in patients in the oldest age quartile (81.6 years, 32.3% mortality) compared to the youngest quartile (55.5 years, 7% mortality). The finding of diverging clinical outcomes extended to the 30‐day but also 8‐year mark. Conclusions Our data suggest there is a high 1‐year mortality in aging HFrEF patients undergoing primary and secondary prevention ICD placement. This highlights the importance of developing better predictive models for mortality in our ICD eligible patient population.

Accelerometer-assessed physical behavior and the association with clinical outcomes in implantable cardioverter-defibrillator recipients: A systematic review

“… 60 , 61 Furthermore, hospitalization and early mortality remain common in the ICD population despite technical improvements and implementation of telemonitoring. 3 , 4 , 62 This review has demonstrated that low PA following device implantation and a decline in PA are both associated with ICD therapy, HF hospitalization, and mortality. Hence, PA as a surrogate for functional capacity could reflect worsening of functional status and be a marker of an increased risk of clinical events and mortality.…”

“…1 However, ICD carriers are at risk of frequent hospital readmission after implantation, increased mortality rates, and psychological distress due to appropriate and inappropriate ICD shocks. 2 , 3 , 4 , 5 , 6 , 7 , 8 The role of physical behavior (PB) is investigated in an attempt to find new predictors and markers of clinical deterioration. Contrary to physical activity (PA), which focuses only on body movement that requires energy expenditure, PB is an umbrella term for an individual’s behavior and activities throughout day and night, which also includes sleep, daily activities, posture, rest-activity patterns, and sedentary behavior.…”

May 2020 at a glance: ischaemic heart failure and sex‐related differences

“…Fudim et al 10 . noted that 1‐year mortality after ICD implantation, for primary or secondary prevention, increased with increasing age reaching an incidence of 32% in the oldest patients (median age 82 years).…”

Secondary prevention of sudden cardiac death

“…There remains, then, an important need to refine both arrhythmic and competing mortality assessment in secondary prevention patients. Indeed, as a recent analysis of ICD recipients in the Veterans Administration System demonstrated, 65 1-year mortality was 33.3% in those greater than 80 years of age, emphasizing the important considerations of integrating and refining our assessment of competing risk in this population.…”