Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators

Daniel B. Kramer, Paul Andrew Friedman, Linda M. Kallinen, Thomas Ben Morrison, Daniel J. Crusan, David O. Hodge, Matthew R. Reynolds, Robert G. Hauser

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Current guidelines do not recommend implantable cardioverter-defibrillator (ICD) implantation in patients with a life expectancy of <1 year. Better methods are needed for identifying patients at high risk for early mortality despite ICD therapy. To develop and validate a risk prediction score to identify patients at high risk for death within 1 year despite ICD therapy. Detailed clinical data were collected on a large observational cohort of ICD patients from 3 tertiary care centers. One-third of the patients were randomly selected to form the prediction group (PG) from which a risk score was developed using logistic regression. This score was then applied to the remaining two-thirds of the cohort (validation group [VG]) to assess the risk score's predictive accuracy. The total cohort included 2717 ICD patients (mean age = 64.6 ± 14.5, male = 77.2%, primary prevention = 74.7%). A simple risk score incorporating peripheral arterial disease, age < 70 years, creatinine < 2.0 mg/dL, and ejection fraction ≤20% (PACE) accurately predicted 1-year mortality in the VG. Patients with a risk score of <3 had a >4-fold excess 1-year mortality compared with patients with a risk score of <3 (16.5% vs 3.5%; P <.0001). Risk reduction provided by ICD therapy in this cohort is not known given the lack of a control group. A simple risk score accurately predicts 1-year mortality in ICD patients, as patients with a PACE risk score of <3 are at high risk despite ICD therapy.

Original languageEnglish (US)
Pages (from-to)42-46
Number of pages5
JournalHeart Rhythm
Volume9
Issue number1
DOIs
StatePublished - Jan 2012

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Implantable Defibrillators
Mortality
Risk Reduction Behavior
Life Expectancy
Guidelines
Control Groups
Therapeutics

Keywords

  • Implantable cardioverter-defibrillators
  • Outcomes research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators. / Kramer, Daniel B.; Friedman, Paul Andrew; Kallinen, Linda M.; Morrison, Thomas Ben; Crusan, Daniel J.; Hodge, David O.; Reynolds, Matthew R.; Hauser, Robert G.

In: Heart Rhythm, Vol. 9, No. 1, 01.2012, p. 42-46.

Research output: Contribution to journalArticle

Kramer, Daniel B. ; Friedman, Paul Andrew ; Kallinen, Linda M. ; Morrison, Thomas Ben ; Crusan, Daniel J. ; Hodge, David O. ; Reynolds, Matthew R. ; Hauser, Robert G. / Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators. In: Heart Rhythm. 2012 ; Vol. 9, No. 1. pp. 42-46.
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