Clinical prediction model for death prior to appropriate therapy in primary prevention implantable cardioverter defibrillator patients with ischaemic heart disease: the FADES risk score.

Abstract

OBJECTIVES:

To construct a risk score out of baseline variables to estimate the risk of death without prior implantable cardioverter defibrillator (ICD) in primary prevention ICD patients with ischaemic heart disease.

DESIGN:

Retrospective cohort study.

SETTING:

Tertiary care facility in The Netherlands.

PATIENTS:

All patients with ischaemic heart disease who received an ICD for primary prevention of sudden cardiac death at the Leiden University Medical Center, Leiden, The Netherlands in the period 1996-2009.

MAIN OUTCOME MEASURE:

All-cause mortality without prior appropriate ICD therapy (anti-tachycardia pacing or shock).

RESULTS:

900 patients (87% men, mean age 64±10 years) were included in the analysis. During a median follow-up of 669 days (IQR 363-1322 days), 150 patients (17%) died and 191 (21%) patients received appropriate device therapy. 114 (13%) patients died without prior appropriate therapy. Stratification of the risk for death without prior appropriate therapy resulted in risk categorisation of patients as low, intermediate or high risk. NYHA ≥III, advanced age, diabetes mellitus, left ventricular ejection fraction ≤25% and a history of smoking were significant independent predictors of death without appropriate ICD therapy. 5-year cumulative incidence for death without prior appropriate therapy ranged from 10% (95% CI 6% to 16%) in low-risk patients to 41% (95% CI 33% to 51%) in high-risk patients.

CONCLUSIONS:

The risk of death without prior appropriate ICD therapy can be predicted in primary prevention ICD patients with ischaemic heart disease, which facilitates patient-tailored risk estimation.

• Authors: Johannes B van Rees, C Jan Willem Borleffs, Guido H van Welsenes, Enno T van der Velde, Jeroen J Bax, Lieselot van Erven, Hein Putter, Johanna G van der Bom, Martin J Schalij
• Journal: Heart (British Cardiac Society) (Heart) Vol. 98 Issue 11 Pg. 872-7 (Jun 2012) ISSN: 1468-201X [Electronic] England
• PMID: 22581736 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Age Distribution
• Aged
• Algorithms
• Death, Sudden, Cardiac (etiology, prevention & control)
• Defibrillators, Implantable (statistics & numerical data)
• Diabetic Cardiomyopathies (mortality)
• Female
• Follow-Up Studies
• Hospitals, University
• Humans
• Incidence
• Male
• Middle Aged
• Myocardial Ischemia (mortality, prevention & control, therapy)
• Netherlands (epidemiology)
• Predictive Value of Tests
• Primary Prevention
• Prospective Studies
• Registries
• Risk Assessment (methods)
• Risk Factors
• Smoking (adverse effects)
• Treatment Outcome