A validated risk model for 1-year mortality after primary prevention implantable cardioverter defibrillator placement.

Heidenreich PA, Tsai V, Curtis J, Wang Y, Turakhia MP, Masoudi FA, Varosy PD, Goldstein MK. A validated risk model for 1-year mortality after primary prevention implantable cardioverter defibrillator placement. American heart journal. 2015 Aug 1; 170(2):281-289.e2.

Related HSR&D Project(s)

• CDA 09-027 – Optimizing Care of Atrial Fibrillation an Atrial Flutter

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVE: We sought to determine survival for patients with heart failure after an implantation of an implantable cardioverter defibrillator (ICD) for primary prevention in the United States and to develop a simple model that would predict mortality risk. BACKGROUND: Clinical trials have found that patients with heart failure with a 1-year mortality risk near 20% may not benefit from an ICD. METHODS: We identified patients from the ICD Registry of the National Cardiovascular Disease Registries who underwent ICD implantation for primary prevention from 2007 to 2009. Two risk scores for mortality were developed in 2 cohorts: one limited to those with a B-type natriuretic peptide (BNP) value and a second for all patients. The scores were obtained from derivation datasets and tested in a validation sets using logistic regression models and classification and regression trees. RESULTS: In a primary prevention population with BNP available (18,725) the 6 variables most predictive of 1-year mortality were age = 75, BNP = 700 pg/mL, chronic lung disease, dialysis, blood urea nitrogen = 30 mg/dL, and systolic blood pressure < 120 mmHg. Patients with zero risk factors had a 3.3% one-year mortality compared to a 66.7% one-year mortality for those with all 6 risk factors. Those with = 3 risk factors (24.0% of the population) had a 25.8% one-year mortality. A second score using a larger cohort that did not consider BNP identified similar risk factors. CONCLUSIONS: A simple validated risk score can identify patients at high and low risk for death within a year after ICD placement. A large fraction of those currently implanted with an ICD in the United States have a high 1-year mortality and may not benefit from ICD therapy.