REPLACE DARE (Death After Replacement Evaluation) Score

Abstract

Few studies have evaluated mortality and associated risk factors following CIED replacement or upgrade procedures. Advanced age, comorbid conditions, and procedure-related complications might contribute to mortality. The REPLACE Registry, a prospective multicenter study that evaluated patients undergoing device replacement with or without planned lead addition or revision, provided a unique opportunity to examine this question. 2 The objectives of the current © 2014 American Heart Association, Inc. Original ArticleBackground-Identifying factors predictive of mortality may be important to decrease risk associated with cardiac implantable electrical device (CIED) replacement procedures. This study aimed to determine whether clinical factors and complications independently associate with death and to develop a mortality risk prediction tool after CIED replacement. Methods and Results-The prospective REPLACE Registry determined 6-month complication and mortality rates after CIED replacement with or without planned lead addition or revision. Vital status was collected. Kaplan-Meier survival and multivariable Cox proportional hazards regression analyses were performed to identify patient, procedural, or complication variables predictive of death. The REPLACE DARE (Death After Replacement Evaluation) Score was constructed using hazard ratios, reflecting relative risk contributions of each variable, combined into an additive mortality risk score equation. At 6 months, 70 of 1744 (4.0%) patients had died. Cox regression analysis found no significant association between major complications and death. However, recent heart failure admission, New York Heart Association class III/IV, antiarrhythmic drug use, cerebrovascular disease, and chronic kidney disease stage were independently associated with 6-month mortality. The REPLACE DARE Score was 2.0±1.4 in survivors versus 3.5±1.8 in nonsurvivors (P<0.001), with predictive receiver operating characteristic value=0.758 (P<0.001). Risk of death was 1.0% for DARE=0 and 55.6% for DARE=7. The hazard ratio was 1.8 for each change of 1 DARE unit. Conclusions-Comorbidities, but not complications, were significantly associated with mortality after CIED replacement.The REPLACE DARE Score is a novel tool that can identify patients with substantial mortality risk. Such patients should have the relative risk and benefit of their procedure considered carefully. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00395447.

Letter by Barra et al Regarding Article, “REPLACE DARE (Death After Replacement Evaluation) Score: Determinants of All-Cause Mortality After Implantable Device Replacement or Upgrade From the REPLACE Registry”

“…The hazard ratio was 1.73 for each change of 1 DARE unit. These findings are consistent with those of Chung et al 1 First, there was a near-doubling of the risk score between nonsurvivors and survivors. Second, when adjusted for the REPLACE DARE score variables, none of the other predictors were retained, as the DARE score itself was uniquely selected with a forward stepwise approach (when using a backward elimination approach, however, renal function was also included in the regression model).…”

“…We read with great interest the article by Chung et al 1 in which the authors used data from the prospective REPLACE Registry to develop a new score that may help identify patients with substantial mortality risk after cardiac implantable electric device replacement.…”

The REPLACE Death After Replacement Evaluation Score for Predicting Mortality After Device Replacement or Upgrade

“…9 In this study, the authors have shown that in the REPLACE registry, comorbidities, but not complications, were associated with 6-month mortality after CIED replacement. On the basis of these findings, they have developed a mortality risk score, the REPLACE DARE Score, for identifying patients with limited expected longevity before the replacement, in whom the relative risk and benefit of the procedure should be carefully considered.…”

Implantable Triboelectric Nanogenerators for Self‐Powered Cardiovascular Healthcare

“…[102][103][104] Typically powered by lithium batteries, the devices must be replaced anywhere between five and ten years after the initial implantation. [105][106][107][108] This requires high-risk repeat invasive surgery, which increases hospital bills, increases the risk of failure or post-surgery complications, and reduces the quality of life of the patient. [109] The most feasible solution is to utilize an energy source that is both durable and flexible, accommodating the high demands of the human body.…”