Cardiovascular Implantable Electronic Devices -> Tachycardia Devices: -> Indications D-AB21 - Real World Outcomes of Patients with an ICD (ID 7) Abstract

D-AB21-03 - Importance Of Patient's Profile In Predicting Mortality After Cardioverter-defibrillator Replacement: Insight From The Decode Study (ID 789)


Background: Device replacement is the ideal time to reassess health care goals regarding continuing ICD therapy. Only few data are available on the decision making at this time.
Objective: To identify factors associated with poor prognosis at the time of ICD replacement and to develop a prognostic index able to stratify those patients (pts) at risk of dying early.
Methods: Detect long-term complications after ICD replacement (DECODE) was a prospective, single-arm, multicenter cohort study aimed at estimating long-term complications in a large population of pts who underwent ICD/CRT-D replacement. Potential predictors of death were investigated, and all these factors were gathered into a survival prediction score.
Results: We included 983 consecutive pts (median age 71 years, 76% male, 55% ischemic, 47% CRT-D). During a median follow-up time of 761 [628-904] days, 114 (12%) pts died: 65 (57%) pts died for cardiovascular reasons (CV), 46 (40%) for non-CV and 3 (3%) for undetermined reasons. At multivariate Cox regression analysis NYHA class III/IV, Ischemic cardiomyopathy, BMI <26, insulin administration, age > 74 years, history of AF and a hospitalization within 30 days before ICD replacement remained associated with death. This score (for each 2-points level) showed a good discriminatory power with an HR of 2.6 (95%CI: 2.2-3.1, p<0.0001). The risk of death increased according to the severity of the risk profile ranging from 0% - very low risk - to 47% - very high risk -. The time to death was significantly shorter among pts with a score > 4.3 points - best cut-off point - (log-rank test, p<0.0001; HR = 7.8 [5.4-11.3]; mortality rate = 23% for pts with score > 4.3, 3% for those with score < 4.3). The number of pts who died was significant higher in those experienced at least one major adverse event compared to those did not (48% vs 10.5% for infective events, p<0.0001; 49% vs 9.4% for HF hospitalization after ICD replacement, p<0.0001, respectively).
Conclusion: A simple score that includes a limited set of variables appears to be predictive for 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 pts.