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Published on: February 28, 2012
Mortality after cardioverter-defibrillator replacement: Results of the DECODE survival score index
Massimo Zoni-Berisso1, Cristian Martignani2, Ernesto Ammendola3
1Padre Antero Micone Hospital, ASL 3 "Genovese", Genova, Italy.
Insights
Device replacement is a key time to reassess implantable cardioverter-defibrillator (ICD) therapy. A new prognostic score (SUSCI) can identify patients at high risk of early death, guiding personalized care decisions.
Area of Science:
- Cardiology
- Medical Devices
- Prognostics
Background:
- Device replacement offers a critical juncture for re-evaluating implantable cardioverter-defibrillator (ICD) therapy continuation.
- Limited data exist regarding decision-making processes at the time of ICD replacement.
Purpose of the Study:
- To identify factors predicting poor prognosis during ICD replacement.
- To develop a prognostic index for stratifying patients at risk of early mortality.
Main Methods:
- Prospective, multicenter cohort study (DECODE) involving patients undergoing ICD/cardiac resynchronization therapy-defibrillator replacement.
- Investigation of potential death predictors and development of a survival score index (SUSCI).
Main Results:
- 983 patients included; 114 (12%) died during follow-up.
- Factors associated with death: NYHA class III/IV, ischemic cardiomyopathy, low BMI, insulin use, age ≥ 75, atrial fibrillation, recent hospitalization.
- SUSCI demonstrated good discriminatory power (HR 2.6), with mortality risk increasing from 0% (low) to 47% (high).
Conclusions:
- A simple prognostic score (SUSCI) effectively predicts mortality in real-world patients undergoing ICD replacement.
- Patient profile evaluation aids in identifying vulnerability and personalizing treatment options, particularly for high-risk individuals.
Background:
Device replacement is the ideal time to reassess health care goals regarding continuing implantable cardioverter-defibrillator (ICD) therapy. Only few data are available on the decision making at this time.
Objectives:
The goals of this study were to identify factors associated with poor prognosis at the time of ICD replacement and to develop a prognostic index able to stratify those patients at risk of dying early.
Methods:
DEtect long-term COmplications after implantable cardioverter-DEfibrillator replacement (DECODE) was a prospective, single-arm, multicenter cohort study aimed at estimating long-term complications in a large population of patients who underwent ICD/cardiac resynchronization therapy - defibrillator replacement. Potential predictors of death were investigated, and all these factors were gathered into a survival score index (SUSCI).
Results:
We included 983 consecutive patients (median age 71 years (63-78)); 750 (76%) were men, 537 (55%) had ischemic cardiomyopathy; 460 (47%) were implanted with cardiac resynchronization therapy - defibrillator. During a median follow-up period of 761 days (interquartile range 628-904 days), 114 patients (12%) died. In multivariate Cox regression analysis, New York Heart Association class III/IV, ischemic cardiomyopathy, body mass index < 26 kg/m2, insulin administration, age ≥ 75 years, history of atrial fibrillation, and hospitalization within 30 days before ICD replacement remained associated with death. The survival score index showed a good discriminatory power with a hazard ratio of 2.6 (95% confidence interval 2.2-3.1; P < .0001). The risk of death increased according to the severity of the risk profile ranging from 0% (low risk) to 47% (high risk).
Conclusion:
A simple score that includes a limited set of variables appears to be predictive of total mortality in an unselected real-world population undergoing ICD replacement. Evaluation of the patient's profile may assist in predicting vulnerability and should prompt individualized options, especially for high-risk patients.
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