Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter‐Defibrillator Generator Changes
Background As patients derive variable benefit from generator changes (GCs) of implantable cardioverter‐defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry,...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.023743 |
| _version_ | 1828036909566263296 |
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| author | Kenneth C. Bilchick Yongfei Wang Jeptha P. Curtis Ramin Shadman Todd F. Dardas Inder Anand Lars H. Lund Ulf Dahlström Ulrik Sartipy Wayne C. Levy |
| author_facet | Kenneth C. Bilchick Yongfei Wang Jeptha P. Curtis Ramin Shadman Todd F. Dardas Inder Anand Lars H. Lund Ulf Dahlström Ulrik Sartipy Wayne C. Levy |
| author_sort | Kenneth C. Bilchick |
| collection | DOAJ |
| description | Background As patients derive variable benefit from generator changes (GCs) of implantable cardioverter‐defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry, patients undergoing GCs of initial non‐cardiac resynchronization therapy PP ICDs in 2012 to 2016, predictors of post‐GC survival and survival benefit versus control heart failure patients without ICDs were assessed. These included predicted annual mortality based on the Seattle Heart Failure Model, left ventricular ejection fraction (LVEF) >35%, and the probability that a patient's death would be arrhythmic (proportional risk of arrhythmic death [PRAD]). In 40 933 patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs (age 67.7±12.0 years, 24.5% women, 34.1% with LVEF >35%), Seattle Heart Failure Model–predicted annual mortality had the greatest effect size for decreased post‐GC survival (P<0.0001). Patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs with LVEF >35% had a lower Seattle Heart Failure Model–adjusted survival versus 23 472 control heart failure patients without ICDs (model interaction hazard ratio, 1.21 [95% CI, 1.11–1.31]). In patients undergoing GCs of initial noncardiac resynchonization therapy PP ICDs with LVEF ≤35%, the model indicated worse survival versus controls in the 21% of patients with a PRAD <43% and improved survival in the 10% with PRAD >65%. The association of the PRAD with survival benefit or harm was similar in patients with or without pre‐GC ICD therapies. Conclusions Patients who received replacement of an ICD originally implanted for primary prevention and had at the time of GC either LVEF >35% alone or both LVEF ≤35% and PRAD <43% had worse survival versus controls without ICDs. |
| first_indexed | 2024-04-10T16:02:57Z |
| format | Article |
| id | doaj.art-c0b3c80126df4503a22e1382c3937db2 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T16:02:57Z |
| publishDate | 2022-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c0b3c80126df4503a22e1382c3937db22023-02-10T09:15:42ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-07-01111310.1161/JAHA.121.023743Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter‐Defibrillator Generator ChangesKenneth C. Bilchick0Yongfei Wang1Jeptha P. Curtis2Ramin Shadman3Todd F. Dardas4Inder Anand5Lars H. Lund6Ulf Dahlström7Ulrik Sartipy8Wayne C. Levy9Department of Medicine University of Virginia Health System Charlottesville VACenter for Outcomes Research and Evaluation Yale‐New Haven Hospital New Haven CTCenter for Outcomes Research and Evaluation Yale‐New Haven Hospital New Haven CTSouthern California Permanente Medical Group Los Angeles CTDepartment of Medicine University of Washington Seattle WAUniversity of Minnesota Minneapolis MNDepartment of Medicine/Cardiology Karolinska University Hospital Stockholm SwedenDepartment of Cardiology and Department of Health, Medicine and Caring Sciences Linkoping University Linkoping SwedenDepartment of Molecular Medicine and Surgery Karolinska Institutet Stockholm SwedenDepartment of Medicine University of Washington Seattle WABackground As patients derive variable benefit from generator changes (GCs) of implantable cardioverter‐defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry, patients undergoing GCs of initial non‐cardiac resynchronization therapy PP ICDs in 2012 to 2016, predictors of post‐GC survival and survival benefit versus control heart failure patients without ICDs were assessed. These included predicted annual mortality based on the Seattle Heart Failure Model, left ventricular ejection fraction (LVEF) >35%, and the probability that a patient's death would be arrhythmic (proportional risk of arrhythmic death [PRAD]). In 40 933 patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs (age 67.7±12.0 years, 24.5% women, 34.1% with LVEF >35%), Seattle Heart Failure Model–predicted annual mortality had the greatest effect size for decreased post‐GC survival (P<0.0001). Patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs with LVEF >35% had a lower Seattle Heart Failure Model–adjusted survival versus 23 472 control heart failure patients without ICDs (model interaction hazard ratio, 1.21 [95% CI, 1.11–1.31]). In patients undergoing GCs of initial noncardiac resynchonization therapy PP ICDs with LVEF ≤35%, the model indicated worse survival versus controls in the 21% of patients with a PRAD <43% and improved survival in the 10% with PRAD >65%. The association of the PRAD with survival benefit or harm was similar in patients with or without pre‐GC ICD therapies. Conclusions Patients who received replacement of an ICD originally implanted for primary prevention and had at the time of GC either LVEF >35% alone or both LVEF ≤35% and PRAD <43% had worse survival versus controls without ICDs.https://www.ahajournals.org/doi/10.1161/JAHA.121.023743generator changeheart failureimplantable cardioverter‐defibrillatorleft ventricular ejection fractionrisk scorerisk stratification |
| spellingShingle | Kenneth C. Bilchick Yongfei Wang Jeptha P. Curtis Ramin Shadman Todd F. Dardas Inder Anand Lars H. Lund Ulf Dahlström Ulrik Sartipy Wayne C. Levy Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter‐Defibrillator Generator Changes Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease generator change heart failure implantable cardioverter‐defibrillator left ventricular ejection fraction risk score risk stratification |
| title | Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter‐Defibrillator Generator Changes |
| title_full | Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter‐Defibrillator Generator Changes |
| title_fullStr | Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter‐Defibrillator Generator Changes |
| title_full_unstemmed | Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter‐Defibrillator Generator Changes |
| title_short | Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter‐Defibrillator Generator Changes |
| title_sort | survival probability and survival benefit associated with primary prevention implantable cardioverter defibrillator generator changes |
| topic | generator change heart failure implantable cardioverter‐defibrillator left ventricular ejection fraction risk score risk stratification |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.023743 |
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