Reassessment of cardiovascular parameters and comorbidities in implantable cardioverter-defibrillator patients at the time of first replacement
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Reassessment of cardiovascular parameters and comorbidities in implantable cardioverter-defibrillator patients at the time of first replacement. / Wuest, Sandra; Twerenbold, Raphael; Kühne, Michael; Reichlin, Tobias; Sticherling, Christian; Osswald, Stefan; Schaer, Beat.
In: CLIN CARDIOL, Vol. 41, No. 1, 01.2018, p. 57-62.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Reassessment of cardiovascular parameters and comorbidities in implantable cardioverter-defibrillator patients at the time of first replacement
AU - Wuest, Sandra
AU - Twerenbold, Raphael
AU - Kühne, Michael
AU - Reichlin, Tobias
AU - Sticherling, Christian
AU - Osswald, Stefan
AU - Schaer, Beat
N1 - © 2018 Wiley Periodicals, Inc.
PY - 2018/1
Y1 - 2018/1
N2 - BACKGROUND: Guidelines provide extensive recommendations regarding implantable cardioverter-defibrillator (ICD) implantation. However, ICD replacement at the time of battery depletion is rarely studied.HYPOTHESIS: Our objectives were to identify patients at high-risk of death after ICD replacement, with a reassessment of changes in risk factors and comorbidities at the time of replacement, and to determine predictors for subsequent mortality.METHODS: Patients undergoing ICD replacement for regular battery depletion were selected from a prospective single-center ICD registry. Both at implant and replacement, 3 demographic parameters, 9 cardiovascular parameters, 5 comorbidities, and 4 laboratory parameters were collected. Cox proportional hazard analyses were used.RESULTS: We included 308 patients who were predominantly male (86%) with a median age at ICD replacement of 66 years. Replacement was performed 65 months (interquartile range, 52-91) after implantation. Median follow-up after replacement was 41 months, during which 82 patients (27%) died. Multivariable analysis revealed 4 independent predictors of mortality after ICD replacement: age/year (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.03-1.08, P = 0.01), worsening heart failure by 1 class (HR: 1.53, 95% CI: 1.15-2.03, P = 0.003), presence of left bundle branch block (HR: 1.98, 95% CI: 1.22-3.23, P = 0.006), and ICD therapy prior to replacement (HR: 2.22, 95% CI: 1.37-3.58, P = 0.001). Incorporated into a dichotomous score, they strongly correlated with mortality at 5 years after replacement (5% with 0 parameters, 15% with 1 parameter, and 30%-55% with >2 parameters).CONCLUSIONS: Focused reassessment of selected patient characteristics at the time of ICD replacement correlates with subsequent mortality and can impact decision making at this point in time.
AB - BACKGROUND: Guidelines provide extensive recommendations regarding implantable cardioverter-defibrillator (ICD) implantation. However, ICD replacement at the time of battery depletion is rarely studied.HYPOTHESIS: Our objectives were to identify patients at high-risk of death after ICD replacement, with a reassessment of changes in risk factors and comorbidities at the time of replacement, and to determine predictors for subsequent mortality.METHODS: Patients undergoing ICD replacement for regular battery depletion were selected from a prospective single-center ICD registry. Both at implant and replacement, 3 demographic parameters, 9 cardiovascular parameters, 5 comorbidities, and 4 laboratory parameters were collected. Cox proportional hazard analyses were used.RESULTS: We included 308 patients who were predominantly male (86%) with a median age at ICD replacement of 66 years. Replacement was performed 65 months (interquartile range, 52-91) after implantation. Median follow-up after replacement was 41 months, during which 82 patients (27%) died. Multivariable analysis revealed 4 independent predictors of mortality after ICD replacement: age/year (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.03-1.08, P = 0.01), worsening heart failure by 1 class (HR: 1.53, 95% CI: 1.15-2.03, P = 0.003), presence of left bundle branch block (HR: 1.98, 95% CI: 1.22-3.23, P = 0.006), and ICD therapy prior to replacement (HR: 2.22, 95% CI: 1.37-3.58, P = 0.001). Incorporated into a dichotomous score, they strongly correlated with mortality at 5 years after replacement (5% with 0 parameters, 15% with 1 parameter, and 30%-55% with >2 parameters).CONCLUSIONS: Focused reassessment of selected patient characteristics at the time of ICD replacement correlates with subsequent mortality and can impact decision making at this point in time.
KW - Aged
KW - Aged, 80 and over
KW - Comorbidity
KW - Death, Sudden, Cardiac/epidemiology
KW - Defibrillators, Implantable
KW - Female
KW - Follow-Up Studies
KW - Heart Failure/epidemiology
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Prospective Studies
KW - Registries
KW - Risk Assessment/methods
KW - Risk Factors
KW - Switzerland/epidemiology
KW - Tachycardia, Ventricular/epidemiology
KW - Time Factors
U2 - 10.1002/clc.22849
DO - 10.1002/clc.22849
M3 - SCORING: Journal article
C2 - 29355999
VL - 41
SP - 57
EP - 62
JO - CLIN CARDIOL
JF - CLIN CARDIOL
SN - 0160-9289
IS - 1
ER -
