TY - JOUR
T1 - Mortality risk following replacement implantable cardioverter-defibrillator implantation at end of battery life
T2 - Results from the NCDR®
AU - Kramer, Daniel B.
AU - Kennedy, Kevin F.
AU - Spertus, John A.
AU - Normand, Sharon Lise
AU - Noseworthy, Peter A.
AU - Buxton, Alfred E.
AU - Josephson, Mark E.
AU - Zimetbaum, Peter J.
AU - Mitchell, Susan L.
AU - Reynolds, Matthew R.
N1 - Funding Information:
Dr. Kramer is the Lois Green Scholar at the Hebrew SeniorLife Institute for Aging Research and is additionally supported by an award from the John A. Hartford Foundation and a career development award from the Harvard Clinical and Translational Science Center. Dr. Mitchell is supported by NIH-NIA K24AG033640. This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR). The views expressed in this manuscript represent those of the author(s) and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com . ICD Registry is an initiative of the American College of Cardiology Foundation and the Heart Rhythm Society. Dr. Spertus reports a contract from the American College of Cardiology Foundation to provide analytic support for the National Cardiovascular Data Registry. Dr. Buxton has received honoraria from St. Jude Medical for serving on DSMB for a clinical trial (unrelated to ICDs); from Medtronic for speaking at educational symposia and serving on Events Committee for a clinical trial (not related to ICDs); and from Boston Scientific for serving on Events Committee for a clinical trial (not related to ICDs). Dr. Josephson has received honoraria from Medtronic for educational courses and small advisory input; and from Biotronik for educational courses. Dr. Reynolds has received research support and consulting income from Medtronic
PY - 2014/2
Y1 - 2014/2
N2 - Background Implantable cardioverter-defibrillator (ICD) generator replacement at the end of expected battery life accounts for a substantial proportion of all ICD implant procedures. However, little is known about the predictors of mortality following ICD generator replacement. Objective The purpose of this study was to identify clinical and procedural factors associated with death following ICD generator replacement. Methods Patients from the National Cardiovascular Data Registry (NCDR) ICD Registry receiving ICD generator replacements at the end of device battery life between January 1, 2005, and March 30, 2010, were eligible. Predictors of mortality were determined using multivariable Cox regression. Results Analysis of 111,826 patients (mean age 70.7 ±12.4, 75.5% male) revealed 1-, 3-, and 5-year mortality of 9.8%, 27.0%, and 41.2%, respectively. After adjustment, atrial fibrillation (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.20-1.27) and congestive heart failure (HR 1.21, 95% CI 1.16-1.27) predicted worse survival. In addition to older age (HR 1.43, 95% CI 1.41-1.45), several noncardiac conditions were also associated with poorer survival, including chronic lung disease (HR 1.53, 95% CI 1.49-1.57), cerebrovascular disease (HR 1.28, 95% CI 1.24-1.32), diabetes (HR 1.27, 95% CI 1.23-1.30), and lower glomerular filtration rate (HR 1.15 for each 10-unit increment decline, 95% CI 1.14-1.16). In the absence of a non-ICD control group, risk reduction provided by ICD therapy in this cohort is not known. Conclusion In addition to age, atrial fibrillation, and congestive heart failure, noncardiac comorbidities are associated with higher mortality following ICD replacement, which should be considered in the decision to undergo this procedure.
AB - Background Implantable cardioverter-defibrillator (ICD) generator replacement at the end of expected battery life accounts for a substantial proportion of all ICD implant procedures. However, little is known about the predictors of mortality following ICD generator replacement. Objective The purpose of this study was to identify clinical and procedural factors associated with death following ICD generator replacement. Methods Patients from the National Cardiovascular Data Registry (NCDR) ICD Registry receiving ICD generator replacements at the end of device battery life between January 1, 2005, and March 30, 2010, were eligible. Predictors of mortality were determined using multivariable Cox regression. Results Analysis of 111,826 patients (mean age 70.7 ±12.4, 75.5% male) revealed 1-, 3-, and 5-year mortality of 9.8%, 27.0%, and 41.2%, respectively. After adjustment, atrial fibrillation (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.20-1.27) and congestive heart failure (HR 1.21, 95% CI 1.16-1.27) predicted worse survival. In addition to older age (HR 1.43, 95% CI 1.41-1.45), several noncardiac conditions were also associated with poorer survival, including chronic lung disease (HR 1.53, 95% CI 1.49-1.57), cerebrovascular disease (HR 1.28, 95% CI 1.24-1.32), diabetes (HR 1.27, 95% CI 1.23-1.30), and lower glomerular filtration rate (HR 1.15 for each 10-unit increment decline, 95% CI 1.14-1.16). In the absence of a non-ICD control group, risk reduction provided by ICD therapy in this cohort is not known. Conclusion In addition to age, atrial fibrillation, and congestive heart failure, noncardiac comorbidities are associated with higher mortality following ICD replacement, which should be considered in the decision to undergo this procedure.
KW - Implantable cardioverter-defibrillator
KW - Outcomes research
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U2 - 10.1016/j.hrthm.2013.10.046
DO - 10.1016/j.hrthm.2013.10.046
M3 - Article
C2 - 24513917
AN - SCOPUS:84893688475
SN - 1547-5271
VL - 11
SP - 216
EP - 221
JO - Heart rhythm
JF - Heart rhythm
IS - 2
ER -