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Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit: Insights From the DANISH Trial

Søren Lund Kristensen1, Wayne C Levy2, Ramin Shadman3

  • 1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.

JACC. Heart Failure
|July 15, 2019
PubMed

Insights

Implantable cardioverter-defibrillators (ICDs) benefit nonischemic heart failure patients with a high predicted risk of sudden cardiac death (SCD), as identified by the Seattle Proportional Risk Model (SPRM). Patients with lower SPRM scores did not show a mortality benefit from ICDs.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Trials

Background:

  • The efficacy of implantable cardioverter-defibrillators (ICDs) for primary prevention in nonischemic heart failure remains debated.
  • Established risk prediction models can help identify patients most likely to benefit from ICD implantation.

Purpose of the Study:

  • To determine if patients with nonischemic heart failure benefit from ICD implantation based on risk stratification using the Seattle Heart Failure Model (SHFM) and Seattle Proportional Risk Model (SPRM).

Main Methods:

  • The study analyzed 1,116 patients from the Danish study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on mortality (DANISH) trial.
  • Patients were stratified by median scores from the SHFM and SPRM.
  • The effect of ICD implantation on all-cause mortality and sudden cardiac death (SCD) was evaluated.

Main Results:

  • ICD implantation significantly reduced all-cause mortality in patients with SPRM scores above the median (HR: 0.63; 95% CI: 0.43 to 0.94).
  • No significant mortality benefit was observed in patients with lower SPRM scores (HR: 1.08; 95% CI: 0.78 to 1.49; p for interaction = 0.04).
  • A significant interaction was found for combined high SPRM and high SHFM scores, where ICDs reduced mortality (HR: 0.45; 95% CI: 0.25 to 0.80).

Conclusions:

  • Nonischemic heart failure patients with a higher predicted likelihood of sudden cardiac death (SCD), indicated by a higher SPRM score, appear to benefit from ICD implantation.
  • Risk stratification using models like SPRM may help personalize ICD therapy decisions in nonischemic heart failure.
Abstract

Keywords:
implantable cardioverter-defibrillatornonischemic cardiomyopathyrisk prediction

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