Characteristics and outcomes of patients receiving new and replacement implantable cardioverter-defibrillators: Results from the NCDR

Daniel B. Kramer, Kevin F. Kennedy, Peter A. Noseworthy, Alfred E. Buxton, Mark E. Josephson, Sharon Lise Normand, John A. Spertus, Peter J. Zimetbaum, Matthew R. Reynolds, Susan L. Mitchell

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Background-Little is known about the clinical features, procedural risks, or survival of patients receiving replacement versus new implantable cardioverter-defibrillators (ICDs). Methods and Results-Entries in the National Cardiovascular Data Registry (NCDR) ICD Registry from 2005 through 2010 were eligible for inclusion (n=463 978). Baseline demographic data, clinical information, and procedural variables were compared between patients receiving new (n=359 993; 77.6%) and replacement (n=103 985; 22.4%) ICDs and entered into a propensity match model to determine adjusted survival rates. Patients receiving replacement ICDs were older (70.7 versus 67.5 years of age) and more likely to have atrial fibrillation (41.8% versus 31.4%; P<0.001) and ventricular tachycardia (60.5% versus 33.9%; P<0.001) compared with patients receiving new ICDs. Median battery life was only 4.6 years (25%-75% interquartile range, 3.7-5.8) for all replaced devices, 5.8 (25%-75% interquartile range, 4.2-7.5) for single-chamber, 5.1 (25%-75% interquartile range, 4.1-6.1) for dual-chamber, and 3.9 (25%-75% interquartile range, 3.2-4.6) years for biventricular devices. Patients receiving replacement ICDs had lower rates of index admission complications (0.9% versus 3.2%; P<0.001) but greater risk for death compared receiving patients receiving new ICDs in unadjusted analysis (hazard ratio, 1.18; 95% confidence interval, 1.16-1.20; P<0.0001) and after propensity-score matching (hazard ratio, 1.28; 95% confidence interval, 1.25-1.30; P<0.0001). Conclusions-Patients receiving replacement ICDs are older and at greater risk for death compared with those receiving initial ICD implants. The battery life of initial ICDs is shorter than previously reported.

Original languageEnglish (US)
Pages (from-to)488-497
Number of pages10
JournalCirculation: Cardiovascular Quality and Outcomes
Volume6
Issue number4
DOIs
StatePublished - Jul 1 2013

Keywords

  • Death, sudden
  • Defibrillation
  • Implantable cardioverter-defibrillators

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Kramer, D. B., Kennedy, K. F., Noseworthy, P. A., Buxton, A. E., Josephson, M. E., Normand, S. L., Spertus, J. A., Zimetbaum, P. J., Reynolds, M. R., & Mitchell, S. L. (2013). Characteristics and outcomes of patients receiving new and replacement implantable cardioverter-defibrillators: Results from the NCDR. Circulation: Cardiovascular Quality and Outcomes, 6(4), 488-497. https://doi.org/10.1161/CIRCOUTCOMES.111.000054