Predicting Long term survival after de novo cardioverter defibrillator implantation for primary prevention
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Authors
Wang, Chang (Nancy)
Date
Type
thesis
Language
eng
Keyword
Pacemaker , Heart failure , Defibrillator , Long-term outcomes , Health services research , Prediction model
Alternative Title
Abstract
BACKGROUND: Implantable cardioverter-defibrillator (ICD) therapy is the main intervention to reduce risk of sudden cardiac death in patients with reduced ejection fraction cardiomyopathy for primary prevention. While the mortality benefit of ICD insertion has been established in landmark randomized controlled trials, little is known about the long-term outcomes of patients with ICDs in clinical practice.
OBJECTIVES: (1) Describe long-term survival of patients undergoing ICD implantation for primary prevention in the real world. (2) Develop risk prediction model for 10-year survival after ICD implant using baseline clinical and demographic factors.
METHODS: In a multicenter, population-based registry of all ICD patients across 18 centers in Ontario, 5097 patients receiving ICD implant for primary prevention from February 2007 to March 2011 were followed 10 years after device implant. Patients were randomly split 2:1 into derivation and internal validation cohorts to develop and validate a prognostic model using Cox regression and predictors measured at initial ICD evaluation.
RESULTS: In the derivation cohort, mean age was 65.3 years (standard deviation [SD] 11.0), 664 patients were female (19.5%) and 2344 patients (69.0%) had ischemic cardiomyopathy for primary disease indication. 10-year survival was 45.7% (95% confidence interval [CI] 44.0% to 47.4%). The final prediction model included age, sex, ischemic vs. non-ischemic cardiomyopathy, urgency of procedure, New York Heart Association classification, left ventricular ejection fraction, comorbidities (diabetes, hypertension, stroke, smoking, peripheral vascular disease, chronic obstructive lung disease and dialysis), and biomarkers at time of ICD assessment (sodium, hemoglobin, renal function, QRS on electrocardiogram). This model had good discrimination in derivation (AUC 0.80; 95% CI 0.78, 0.81) and validation samples (AUC 0.79, 95% CI 0.77, 0.81). Sensitivity analyses showed that the addition of device type, provider factors (implantation site, implanter volume, physician main specialty), sex-related interaction terms, and frailty scores did not significantly improve the prediction model.
CONCLUSION: A combination of demographic and patient factors determined at baseline evaluation for device therapy enabled the prediction of 10-year survival in patients undergoing ICD for primary prevention in the clinical practice. These findings may be useful in monitoring and targeting future prevention strategies to enhance longevity in this high-risk population.
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ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.