Predicting Early Mortality Among Implantable Defibrillator Patients Treated With Cardiac Resynchronization Therapy

Autor: Beat Schaer, Christian Sticherling, Frederik H. Verbrugge, Nick van Boven, Maximo Rivero-Ayerza, Victor A. Umans, Marcoen F. Scholten, Dominic A.M.J. Theuns, Tim Hesselink, Felix Zijlstra
Přispěvatelé: Clinical sciences, Medicine and Pharmacy academic/administration, Cardiology, Intensive Care
Rok vydání: 2018
Předmět:
Male
medicine.medical_treatment
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Implantable defibrillator
Ventricular Function
Left
Heart Failure/diagnosis
Cardiac Resynchronization Therapy
Switzerland/epidemiology
0302 clinical medicine
Belgium
Risk Factors
030212 general & internal medicine
Myocardial infarction
Registries
Netherlands
Framingham Risk Score
Ejection fraction
Registries/statistics & numerical data
Implantable cardioverter-defibrillator
Prognosis
Defibrillators
Implantable
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
Switzerland
medicine.medical_specialty
Defibrillators
Implantable/statistics & numerical data
Cardiac resynchronization therapy
Electric Countershock
Netherlands/epidemiology
Risk Assessment
03 medical and health sciences
QRS complex
Internal medicine
Electric Countershock/statistics & numerical data
medicine
Cardiac Resynchronization Therapy/methods
Humans
cardiovascular diseases
Mortality
Risk Assessment/methods
Belgium/epidemiology
Aged
Heart Failure
business.industry
Stroke Volume
medicine.disease
Heart failure
business
Zdroj: Journal of Cardiac Failure, 25(10), 812-818. Churchill Livingstone
ISSN: 1532-8414
1071-9164
Popis: 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.
Databáze: OpenAIRE
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