Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators

Abstract

This study determined the impact of clinical characteristics on shock occurrence and survival in patients with implantable cardioverter-defibrillator (ICD). Methods and Results: During a follow-up of 27 ± 18 months, the actuarial incidence of appropriate shocks in 200 consecutive patients was 18, 36 and 72% at 1, 3, and 5 years, respectively. Coronary artery disease was the only significant predictor for shock occurrence (relative risk 1.32, p = 0.03). The actuarial incidence of total mortality was 10, 17 and 33% at 1, 3, and 5 years, respectively. The most powerful predictors for total mortality were: New York Heart Association functional class (NYHA) III (relative risk 4.8, p = 0.001) and a history of congestive cardiac failure (relative risk 3.6, p = 0.01). Conclusion: During long-term follow-up, the majority of patients receive appropriate shocks. No strong predictors for shock occurrence can be identified from the data analyzed. A history of congestive cardiac failure and the NYHA III are the most powerful predictors for total mortality. These clinical factors may provide valuable criteria to identify patients who will benefit from the implantation of ICD.

Quality of life predicts one-year survival in patients with implantable cardioverter defibrillators

“…NYHA classification also achieved a significant association with survival in univariate analysis, but not in multivariate analysis in this study. This finding was different from two studies [20,21] in which NYHA classification (worse HF) was a significant independent predictor of mortality after adjusting for the clinical and demographic predictor variables such as EF, history of coronary artery disease, VT, VF, dilated cardiomyopathy, cardiac arrest, gender, and age.…”

“…In these studies, QOL was identified as a significant independent predictor of mortality. Previous studies of survival in ICD recipients found that EF [4,[16][17][18][19], NYHA classification [16,17,20,21], ICD shocks [20,22], gender [20], and history of sustained VT [23] predicted mortality. In this study, EF was a significant predictor in univariate analysis, however, in the multivariate analysis, EF did not have a significantly independent relationship to survival.…”

“…No studies evaluate the relationship between QOL and mortality in patients who received ICDs. Among ICD recipients, left ventricular ejection fraction (EF) [4,[16][17][18][19], New York Heart Association (NYHA) classification [5,16,20,21], ICD shocks [20,22], a history of sustained ventricular tachycardia (VT) [23], age [22], and gender [20] predicted long-term mortality.…”

“…The first year of ICD treatment probably is the critical period for patients. Most studies of mortality in ICD recipients investigated predictors of long-term mortality [4,5,[16][17][18][19][20][21][22][23], but not of mortality in the first year. Identification of predictors of mortality in the first year after ICD implantation may assist in developing health care programs for patients who receive ICDs.…”

Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapy During Long-Term Follow-up of Patients With Coronary Artery Disease

“…11,12) Reduced left ventricular ejection fraction has been shown to increase the rate of ICD therapy delivery and mortality in several studies, 13,14) but was not predictive in others. 15,16) The time interval between myocardial infarction and device implantation may play an important role in determining which patients are at increased risk. Data from the MADIT II trial suggest that mortality risk in patients with ejection fraction 30% or lower increases as a function of time from myocardial infarction.…”