1. Mortality after cardioverter-defibrillator replacement: Results of the DECODE survival score index
- Author
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Attilio Pierantozzi, Giovanni Licciardello, Maria Lucia Narducci, Biagio Sassone, Cristian Martignani, Sergio Setti, Gianfranco Ciaramitaro, T Infusino, Davide Caruso, Carlotta Terzaghi, Ernesto Ammendola, Pasquale Notarstefano, Leonardo Calò, V. Carinci, Gennaro Miracapillo, Mauro Biffi, C Ferretti, Massimo Zoni-Berisso, Maurizio Malacrida, and Mauro Zennaro
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Population ,Replacement ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Prognostic index ,Implantable cardioverter-defibrillator ,NO ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,education ,Shared decision making ,Aged ,Outcome ,Aged, 80 and over ,Heart Failure ,education.field_of_study ,Ischemic cardiomyopathy ,business.industry ,Proportional hazards model ,Middle Aged ,Defibrillators, Implantable ,Survival Rate ,Death, Sudden, Cardiac ,Italy ,Female ,Cardiology and Cardiovascular Medicine ,business ,Decision Making, Shared ,Body mass index ,Follow-Up Studies ,Cohort study - Abstract
Background Device replacement is the ideal time to reassess health care goals regarding continuing implantable cardioverter-defibrillator (ICD) therapy. Only few data are available on the decision making at this time. Objectives The goals of this study were to identify factors associated with poor prognosis at the time of ICD replacement and to develop a prognostic index able to stratify those patients at risk of dying early. Methods DEtect long-term COmplications after implantable cardioverter-DEfibrillator replacement (DECODE) was a prospective, single-arm, multicenter cohort study aimed at estimating long-term complications in a large population of patients who underwent ICD/cardiac resynchronization therapy – defibrillator replacement. Potential predictors of death were investigated, and all these factors were gathered into a survival score index (SUSCI). Results We included 983 consecutive patients (median age 71 years (63-78)); 750 (76%) were men, 537 (55%) had ischemic cardiomyopathy; 460 (47%) were implanted with cardiac resynchronization therapy – defibrillator. During a median follow-up period of 761 days (interquartile range 628–904 days), 114 patients (12%) died. In multivariate Cox regression analysis, New York Heart Association class III/IV, ischemic cardiomyopathy, body mass index Conclusion A simple score that includes a limited set of variables appears to be predictive of total mortality in an unselected real-world population undergoing ICD replacement. Evaluation of the patient’s profile may assist in predicting vulnerability and should prompt individualized options, especially for high-risk patients.
- Published
- 2021