Predicting outcome after cardiac resynchronisation therapy defibrillator implantation: the cardiac resynchronisation
Baptiste Maille1,2, Alexandre Bodin3, Arnaud Bisson3
1Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France baptiste.maille@ap-hm.fr.
Insights
A new CRT-D Futility score identifies patients at high risk of death within one year of cardiac resynchronisation therapy defibrillator implantation. This tool aids in optimizing healthcare decisions for CRT-D therapy.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- The comparative benefit of cardiac resynchronisation therapy defibrillator (CRT-D) versus CRT pacemaker is debated.
- Identifying patients with poor outcomes post-CRT-D implantation is crucial for optimizing therapy.
Purpose of the Study:
- To identify patients experiencing poor outcomes within one year of CRT-D implantation.
- To develop and validate a predictive score for CRT-D futility.
Main Methods:
- A nationwide cohort of 23,029 patients receiving prophylactic CRT-D in France (2010-2019) was analyzed.
- A prediction model for 1-year all-cause mortality (futility) was derived and validated using split-sample validation.
- Logistic regression identified key predictors of futility, including age, comorbidities, and heart failure history.
Main Results:
- 1604 deaths (22.8%) occurred within one year of CRT-D implantation.
- The CRT-D Futility score incorporated predictors like older age, diabetes, and heart failure history.
- The score demonstrated good predictive accuracy (AUC 0.716 in derivation, 0.692 in validation) and outperformed existing scores.
Conclusions:
- The developed CRT-D Futility score is a relevant tool for predicting early mortality after CRT-D implantation.
- This score can aid in optimizing healthcare decision-making for patients undergoing CRT-D therapy.
- The score identified 15.9% of patients as high-risk for futility.
Background:
Risk-benefit for cardiac resynchronisation therapy (CRT) defibrillator (CRT-D) over CRT pacemaker remains a matter of debate. We aimed to identify patients with a poor outcome within 1 year of CRT-D implantation, and to develop a CRT-D Futility score.
Methods:
Based on an administrative hospital-discharge database, all consecutive patients treated with prophylactic CRT-D implantation in France (2010-2019) were included. A prediction model was derived and validated for 1-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation.
Results:
Among 23 029 patients (mean age 68±10 years; 4873 (21.2%) women), 7016 deaths were recorded (yearly incidence rate 7.2%), of which 1604 (22.8%) occurred within 1 year of CRT-D implantation. In the derivation cohort (n=11 514), the final logistic regression model included-as main predictors of futility-older age, diabetes, mitral regurgitation, aortic stenosis, history of hospitalisation with heart failure, history of pulmonary oedema, atrial fibrillation, renal disease, liver disease, undernutrition and anaemia. Area under the curve for the CRT-D Futility score was 0.716 (95% CI: 0.698 to 0.734) in the derivation cohort and 0.692 (0.673 to 0.710) in the validation cohort. The Hosmer-Lemeshow test had a p-value of 0.57 suggesting accurate calibration. The CRT-D Futility score outperformed the Goldenberg and EAARN scores for identifying futility. Based on the CRT-D Futility score, 15.9% of these patients were categorised at high risk (predicted futility of 16.6%).
Conclusions:
The CRT-D Futility score, established from a large nationwide cohort of patients treated with CRT-D, may be a relevant tool for optimising healthcare decision-making.
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