Comparison of mortality prediction scores in elderly patients with ICD for heart failure with reduced ejection...

Area of Science:

• Cardiology
• Geriatric Medicine
• Medical Device Research

Background:

• Assessing mortality risk in elderly patients (≥75 years) with implantable cardioverter-defibrillators (ICDs) is crucial.
• Existing risk scores (MADIT-II, FADES, PACE, SHOCKED) have uncertain utility in this specific demographic.
• This study addresses the need for validated prognostic tools in geriatric ICD patients.

Purpose of the Study:

• To compare the predictive accuracy of MADIT-II, FADES, PACE, and SHOCKED scores.
• To evaluate the one-year and long-term all-cause mortality prediction in geriatric ICD patients.
• To determine the most effective risk score for this population.

Main Methods:

• Retrospective observational study of 189 geriatric ICD patients.
• Comparison of baseline characteristics and laboratory variables between mortality groups.
• Calculation of MADIT-II, FADES, PACE, and SHOCKED scores at ICD implantation.
• Receiver-operating curve (ROC) analysis to compare predictive values for one-year and long-term mortality.

Main Results:

• MADIT-II score showed significant predictive value for one-year mortality (AUC 0.83) and long-term mortality (AUC 0.68).
• Optimal cutoff for one-year mortality: ≥3 (87% sensitivity, 74% specificity).
• Optimal cutoff for long-term mortality: ≥2 (83% sensitivity, 43% specificity).
• MADIT-II outperformed FADES, PACE, and SHOCKED scores in predicting mortality in this cohort.

Conclusions:

• The MADIT-II score is a valuable prognostic tool for predicting both short-term and long-term mortality in elderly patients with ICDs.
• MADIT-II demonstrates superior predictive performance compared to FADES, PACE, and SHOCKED scores in this geriatric population.
• These findings support the use of the MADIT-II score for risk stratification in older adults receiving ICDs for heart failure.