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Published on: February 28, 2012
Survival After Secondary Prevention Implantable Cardioverter-Defibrillator Placement: An Analysis From the NCDR ICD
David F Katz1, Pamela Peterson2, Ryan T Borne1
1Division of Cardiology, University of Colorado, Denver, Colorado; Colorado Cardiovascular Outcomes Research Group, Denver, Colorado.
Insights
Nearly 90% of patients receiving a secondary prevention implantable cardioverter-defibrillator (ICD) survive one year. The risk of death for ICD patients varies, being highest for those with sudden cardiac death or ventricular tachycardia.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Limited data exists on the utilization and outcomes of implantable cardioverter-defibrillators (ICDs) for secondary prevention of sudden cardiac death (SCD).
- Understanding contemporary clinical practice patterns and survival risks associated with secondary prevention ICDs is crucial.
Purpose of the Study:
- To define the patient characteristics and mortality risks associated with secondary prevention implantable cardioverter-defibrillators (ICDs).
- To evaluate survival outcomes in patients receiving ICDs for secondary prevention in current clinical practice.
Main Methods:
- Utilized data from the National Cardiovascular Data Registry (NCDR) ICD Registry (2006-2009).
- Linked registry data to the Social Security Death Master File for mortality assessment.
- Included patients with a history of tachycardic arrest/sustained ventricular tachycardia (SCD/VT) or syncope without SCD/VT.
- Employed Kaplan-Meier survival analysis and Cox proportional hazards modeling to assess mortality and risk.
Main Results:
- The study cohort comprised 46,685 patients (mean age 66 years; 73.5% male; 85% white).
- Overall mortality was 10.4% at 1 year and 16.4% at 2 years.
- Patients with syncope had a lower adjusted 1-year hazard of death (HR: 0.89) compared to those with SCD/VT, though this difference was not significant by 2 years (HR: 0.96).
Conclusions:
- Approximately 90% of patients receiving a secondary prevention ICD are alive at the one-year mark.
- Mortality risk following ICD implantation for secondary prevention is dependent on the specific indication.
- Patients who survive sudden cardiac death or sustained ventricular tachycardia face the highest risk of death within the first year post-implantation.
Objectives:
This study sought to define the characteristics and risks of death of patients receiving a physician-designated secondary prevention implantable cardioverter-defibrillator (ICD) in contemporary clinical practice.
Background:
Data on utilization and outcomes of ICDs for the secondary prevention of sudden cardiac death (SCD) are limited.
Methods:
Patients enrolled in the National Cardiovascular Data Registry's (NCDR) ICD Registry from 2006 to 2009 with a physician-designated secondary prevention indication for ICD implantation were identified and linked to the Social Security Death Master File. Those patients with a history either of tachycardic arrest or sustained ventricular tachycardia (SCD/VT) or of syncope without SCD/VT were included. Kaplan-Meier survival analysis was used to assess mortality. Cox proportional hazards survival modeling was used to assess the risk of death in these groups, adjusting for patient characteristics.
Results:
In the study cohort of 46,685 patients (mean age 66 ± 14 years, 73.5% male, 85% white), 78% had SCD/VT and 22% had syncope. Overall mortality was 10.4% at 1 year and 16.4% at 2 years. Compared with patients having SCD/VT, the adjusted hazard of death at 1 year was lower in the patients having syncope (hazard ratio: 0.89; 95% confidence interval: 0.83 to 0.96) but was not significantly different by 2 years (hazard ratio: 0.96; 95% confidence interval: 0.90 to 1.01).
Conclusions:
Nearly 9 of 10 patients receiving a secondary prevention ICD in clinical practice are alive 1 year after implantation. The risk of death varies by indication and is highest among patients who survive SCD or sustained VT in the first year after device implantation.
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