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Association between the Charlson comorbidity index and outcomes after implantable cardioverter defibrillator

Mustapha M Amin1, Chance M Witt1, Jonathan W Waks2

  • 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

Pacing and Clinical Electrophysiology : PACE
|July 30, 2019
PubMed

Insights

The Charlson Comorbidity Index (CCI) predicts mortality in patients receiving implantable cardioverter defibrillator (ICD) generator replacement. Higher CCI scores indicate increased risk, suggesting careful consideration for ICD benefits in complex patients.

Area of Science:

  • Cardiology
  • Medical Devices
  • Health Outcomes Research

Background:

  • Implantable cardioverter defibrillator (ICD) generator replacement may carry risks for patients with multiple medical comorbidities.
  • The Charlson Comorbidity Index (CCI) is a tool to assess comorbidity burden.

Purpose of the Study:

  • To investigate the association between the CCI and outcomes after ICD generator replacement.
  • To determine if comorbidity burden influences the benefit of ICD generator replacement.

Main Methods:

  • Retrospective analysis of 1421 patients undergoing first ICD generator replacement (2001-2011).
  • Outcomes assessed: all-cause mortality, appropriate ICD therapy, and death before appropriate therapy.
  • Multivariable Cox regression analysis used to evaluate CCI's association with outcomes.

Main Results:

  • Higher CCI scores were significantly associated with increased all-cause mortality (HR 1.10 per point increase, P < .001).
  • Higher CCI scores also predicted death without prior appropriate ICD therapy (HR 1.11, P < .0001).
  • CCI was not associated with the occurrence of appropriate ICD therapy (HR 1.01, P = .53).

Conclusions:

  • The CCI is a significant predictor of mortality following ICD generator replacement.
  • The clinical benefit of ICD replacement in patients with a CCI score of 5 or higher warrants further investigation in prospective studies.
Abstract

Keywords:
Charlson comorbidity indexICDcomorbiditymortality

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