Is Time From Last Hospitalization for Heart Failure to Placement of a Primary Prevention Implantable...

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• Implantable cardioverter-defibrillators (ICDs) are proven for heart failure (HF) patients with reduced ejection fraction on optimal medical therapy.
• The impact of recent HF hospitalization on outcomes after ICD placement is not well-established.

Purpose of the Study:

• To investigate the association between the timing of ICD placement relative to HF hospitalization and patient outcomes.
• To assess the safety and efficacy of primary prevention ICDs in HF patients based on recent hospitalization status.

Main Methods:

• A post hoc analysis of Medicare beneficiaries from the ICD Registry with HF and ejection fraction ≤35% undergoing primary prevention ICD placement.
• Patients were categorized by time from last HF hospitalization: current hospitalization, within 3 months, or >3 months/no prior hospitalization.
• Multivariable logistic regression was used to analyze the association between timing and outcomes.

Main Results:

• The cohort included 81,180 patients; 14% were hospitalized for HF at the time of ICD placement.
• Patients currently or recently hospitalized for HF had higher unadjusted periprocedural complication rates (2.60% vs. 1.71% vs. 1.25%).
• After adjustment, current HF hospitalization significantly increased the risk of 90-day death (OR 2.25) and readmission (OR 1.89).

Conclusions:

• Patients hospitalized for HF recently before primary prevention ICD placement face higher periprocedural complications and 90-day mortality risks.
• The findings suggest that recent HF hospitalization is a critical factor influencing outcomes after ICD implantation.
• Further pragmatic studies are recommended to determine the optimal timing for ICD placement in relation to HF hospitalizations.