Related Experiment Video
Updated: Aug 11, 2026
Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease
Published on: February 18, 2020
One-year mortality after implantable cardioverter-defibrillator placement within the Veterans Affairs Health System
Marat Fudim1,2, Matthew A Carlisle1, Srikant Devaraj3
1Duke University Medical Center, Durham, NC, USA.
Insights
Implantable cardioverter-defibrillator (ICD) therapy did not change 1-year mortality for heart failure patients. However, older patients experienced significantly higher mortality rates post-ICD implantation.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Implantable cardioverter-defibrillators (ICDs) are recommended for heart failure patients with reduced ejection fraction (HFrEF) and a life expectancy over one year.
- Examining mortality trends following ICD implantation is crucial for patient management.
Purpose of the Study:
- To analyze trends in all-cause mortality among US veterans receiving ICDs for primary or secondary prevention of sudden cardiac death.
- To assess the impact of age on 1-year mortality post-ICD implantation in patients with HFrEF.
Main Methods:
- Retrospective analysis of US veterans with HFrEF who received ICDs between 2007 and 2015.
- Utilized Veterans Affairs (VA) Health System data, including ICD-9 codes for ICD implantation and HFrEF diagnosis.
- Assessed all-cause mortality at 1-year post-implantation, with age-stratified analysis.
Main Results:
- No significant change in overall 1-year mortality from 2007 to 2014 (13.1% to 13.4%).
- A significant increase in 1-year mortality was observed in the oldest age quartile (mean age 81.6 years, 32.3% mortality) compared to the youngest (mean age 55.5 years, 7% mortality).
- These outcome disparities were also evident at 30-day and 8-year follow-up points.
Conclusions:
- Aging patients with HFrEF undergoing ICD implantation face high 1-year mortality rates.
- There is a critical need for improved predictive models to identify mortality risk in patients eligible for ICDs.
- Clinical outcomes following ICD implantation vary significantly based on patient age.
Aims:
Implantable cardioverter-defibrillator (ICD) therapy reduces mortality in patients with heart failure and current guidelines advise implantation of ICDs in patients with a life expectancy of >1 year. We examined trends in all-cause mortality in patients who underwent primary or secondary prevention ICD placement in the Veterans Affairs (VA) Health System.
Methods And Results:
US veterans receiving a new ICD placement for primary or secondary prevention of sudden cardiac death between January 2007 and January 2015, who had heart failure with reduced ejection fraction (HFrEF) were included in the analysis. We assessed all-cause mortality 1 year post-ICD implantation. ICD implantation and HFrEF diagnosis were established with associated ICD-9 codes. The VA death registry was utilized to identify mortality rates following ICD placement. Results were subsequently age-stratified. There were 17 901 veterans with HFrEF with ICD placement nationwide. There was no statistically significant difference in 1-year mortality from 2007 (13.1%) to 2014 (13.4%, P > 0.05). There was a significant increase in 1-year mortality in patients in the oldest age quartile (81.6 years, 32.3% mortality) compared to the youngest quartile (55.5 years, 7% mortality). The finding of diverging clinical outcomes extended to the 30-day but also 8-year mark.
Conclusions:
Our data suggest there is a high 1-year mortality in aging HFrEF patients undergoing primary and secondary prevention ICD placement. This highlights the importance of developing better predictive models for mortality in our ICD eligible patient population.
Related Concept Videos
01:30Heart Failure V: Medical Management
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care