Predicting Early Mortality Among Implantable Defibrillator Patients Treated With Cardiac Resynchronization Therapy.
- Theuns DAMJ Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands. Electronic address: d.theuns@erasmusmc.nl.
- Van Boven N Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
- Schaer BA Department of Cardiology, University of Basel Hospital, Basel, Switzerland.
- Hesselink T Department of Cardiology, Medisch Spect Twente, Enschede, the Netherlands.
- Rivero-Ayerza M Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
- Umans V Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
- Sticherling C Department of Cardiology, University of Basel Hospital, Basel, Switzerland.
- Scholten MF Department of Cardiology, Medisch Spect Twente, Enschede, the Netherlands.
- Verbrugge F Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
- Zijlstra F Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands.
- 2019-09-04
Published in:
- Journal of cardiac failure. - 2019
Heart failure
cardiac resynchronization therapy
implantable cardioverter-defibrillator
mortality
risk modeling
Aged
Belgium
Cardiac Resynchronization Therapy
Defibrillators, Implantable
Electric Countershock
Female
Heart Failure
Humans
Kaplan-Meier Estimate
Male
Mortality
Netherlands
Prognosis
Registries
Risk Assessment
Risk Factors
Stroke Volume
Switzerland
Ventricular Function, Left
English
BACKGROUND
The beneficial effects of a cardiac resynchronization defibrillator (CRT-D) in patients with heart failure, low left ventricular ejection fraction (LVEF), and wide QRS have clearly been established. Nevertheless, mortality remains high in some patients. The aim of this study was to develop and validate a risk score to identify patients at high risk for early mortality who are implanted with a CRT-D.
METHODS AND RESULTS
For predictive modelling, 1282 consecutive patients from 5 centers (74% male; median age 66 years; median LVEF 25%; New York Heart Association class III-IV 60%; median QRS-width 160 ms) were randomly divided into a derivation and validation cohort. The primary endpoint is mortality at 3 years. Model development was performed using multivariate logistic regression by checking log likelihood, Akaike information criterion, and Bayesian information criterion. Model performance was validated using C statistics and calibration plots. The risk score included 7 independent mortality predictors, including myocardial infarction, LVEF, QRS duration, chronic obstructive pulmonary disease, chronic kidney disease, hyponatremia, and anemia. Calibration-in-the-large was suboptimal, reflected by a lower observed mortality (44%) than predicted (50%). The validated C statistic was 0.71 indicating modest performance.
CONCLUSION
A risk score based on routine, readily available clinical variables can assist in identifying patients at high risk for early mortality within 3 years after CRT-D implantation.
The beneficial effects of a cardiac resynchronization defibrillator (CRT-D) in patients with heart failure, low left ventricular ejection fraction (LVEF), and wide QRS have clearly been established. Nevertheless, mortality remains high in some patients. The aim of this study was to develop and validate a risk score to identify patients at high risk for early mortality who are implanted with a CRT-D.
METHODS AND RESULTS
For predictive modelling, 1282 consecutive patients from 5 centers (74% male; median age 66 years; median LVEF 25%; New York Heart Association class III-IV 60%; median QRS-width 160 ms) were randomly divided into a derivation and validation cohort. The primary endpoint is mortality at 3 years. Model development was performed using multivariate logistic regression by checking log likelihood, Akaike information criterion, and Bayesian information criterion. Model performance was validated using C statistics and calibration plots. The risk score included 7 independent mortality predictors, including myocardial infarction, LVEF, QRS duration, chronic obstructive pulmonary disease, chronic kidney disease, hyponatremia, and anemia. Calibration-in-the-large was suboptimal, reflected by a lower observed mortality (44%) than predicted (50%). The validated C statistic was 0.71 indicating modest performance.
CONCLUSION
A risk score based on routine, readily available clinical variables can assist in identifying patients at high risk for early mortality within 3 years after CRT-D implantation.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.cardfail.2019.08.018
- PMID 31479745
- Persistent URL
- https://folia.unifr.ch/global/documents/84653
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