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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Developing a risk score to predict mortality in the first year after implantable cardioverter defibrillator
Roman Nevzorov1, Ilan Goldenberg2, Yuval Konstantino3
1Electrophysiology and Pacing Unit and ICCU, Barzilai University Medical Center, Ashkelon, Affiliated with Ben-Gurion University of the Negev, Beer Sheva, Israel.
Insights
A new AAACC score predicts 1-year mortality risk in patients receiving implantable cardioverter defibrillators (ICDs). This score helps identify individuals at higher risk of death, guiding clinical decisions for ICD implantation.
Area of Science:
- Cardiology
- Medical Devices
- Predictive Analytics
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for preventing sudden cardiac death.
- Patients with a life expectancy under one year are typically not candidates for ICD implantation.
- Identifying patients at high risk of early mortality post-implantation is essential for appropriate device selection.
Purpose of the Study:
- To identify independent risk factors for mortality within the first year after ICD or CRT-D implantation.
- To develop and validate a simple risk score for predicting 1-year mortality in this patient population.
Main Methods:
- A prospective analysis of the Israeli ICD Registry involving 2617 patients.
- Comparison of patient groups who died versus survived 1 year post-implantation.
- Development and validation of the AAACC risk score based on identified risk factors.
Main Results:
- Independent risk factors for 1-year mortality included age over 75, atrial fibrillation (AF), chronic lung disease, anemia, and chronic renal failure (CRF).
- The AAACC score, incorporating these factors, showed increasing mortality risk with higher scores (1% for 0 points to 12.5% for >4 points).
- The risk score demonstrated good predictive accuracy with an area under the curve of 0.71 in validation.
Conclusions:
- Age, AF, chronic lung disease, anemia, and CRF are significant predictors of 1-year mortality after ICD implantation.
- The AAACC risk score effectively identifies patients at elevated risk of death within the first year post-implantation.
- This score can aid clinicians in risk stratification and decision-making regarding ICD therapy.
Introduction:
Life expectancy of less than 1 year is usually a contraindication for implantable cardioverter defibrillator (ICD) implantation. The aim was to identify patients at risk of death during the first year after implantation.
Methods And Results:
Data were derived from a prospective Israeli ICD Registry. Two groups of patients were compared, those who died and those who were alive 1 year after ICD implantation. Factors associated with 1-year mortality were identified on a derivation cohort. A risk score was established and validated. A total of 2617 patients have completed 1 year of follow-up after ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Age greater than 75 years (hazard ratio [HR], 2.7; 95% confidence interval [95% CI], 1.6 to 4.4), atrial fibrillation (AF; HR, 1.9; 95% CI, 1.12 to 3.17), chronic lung disease (HR, 2.0; 95% CI, 1.1 to 3.76), anemia (HR, 2.3; 95% CI, 1.3 to 3.93) and chronic renal failure (CRF; HR, 3.4; 95% CI, 1.74 to 6.6) were independent risk factors for 1-year mortality. We propose a simple AAACC ("triple A double C") score for prediction of 1-year mortality after ICD implantation: Age greater than 75 years (3 points(pts)), anemia (2 pts), AF (1 pt), CRF (3 pts) and chronic lung disease (1 pt). Mortality risk increased with rising number of points (from 1% with 0 pts to 12.5% with >4 pts). The risk score was evaluated with receiver operating characteristic curve and the area under the curve of the validation curve is 0.71 (95% CI, 0.66 to 0.76).
Conclusions:
Age greater than 75, AF, chronic lung disease, anemia, and CRF were independent risk factors for 1-year mortality. AAACC risk score identifies patients at high risk of death during 1 year after ICD implantation.
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