CLINICAL RESEARCH: HEART RHYTHM DISORDER
Effect of Cardiac and Noncardiac Conditions on Survival After Defibrillator Implantation
Douglas S. Lee, MD, PhD*, ,#,*,
Jack V. Tu, MD, PhD*, ,#,
Peter C. Austin, PhD*,#,
Paul Dorian, MD, MSc ,#,
Raymond Yee, MD||,
Alice Chong, BSc*,
David A. Alter, MD, PhD*,,# and
Andreas Laupacis, MD, MSc*,,#
* Institute for Clinical Evaluative Sciences, Toronto, Canada
University Health Network, Toronto, Canada
Sunnybrook and Women’s Health Sciences Centre, Toronto, Canada
Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
|| London Health Sciences Centre, London, Canada
# University of Toronto, Toronto, Canada.
Manuscript received November 9, 2006;
revised manuscript received January 26, 2007,
accepted February 27, 2007.
* Reprint requests and correspondence: Dr. Douglas S. Lee, Institute for Clinical Evaluative Sciences, Room G-106, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5. (Email: dlee{at}ices.on.ca).
Objectives: We sought to examine outcomes in recipients of implantable cardioverter-defibrillators (ICDs) and the effect of age, gender, and comorbidities on survival.
Background: Age, gender, and comorbidities may significantly affect outcomes in ICD recipients.
Methods: We examined factors associated with mortality in 2,467 ICD recipients in Ontario, Canada, using a province-wide database. Comorbidities were identified retrospectively by examining all diagnosis codes within the 3 years before implant.
Results: Mean ages at ICD implant were 63.2 ± 12.5 years (1,944 men) and 59.8 ± 15.9 years (523 women). Mortality rates at one and 2 years were 7.8% and 14.0%. Older age at implant increased the risk of death with hazard ratios (HR) of 2.05 (95% confidence interval [CI] 1.70 to 2.47) and 3.00 (95% CI 2.43 to 3.71) for those 65 to 74 years and  75 years, respectively (both p < 0.001), but gender was not a predictor of death. Common noncardiac conditions associated with death included peripheral vascular disease (adjusted HR 1.50, 95% CI 1.18 to 1.91), pulmonary disease (adjusted HR 1.35, 95% CI 1.10 to 1.66), and renal disease (adjusted HR 1.57, 95% CI 1.25 to 1.99). Many ICD recipients had prior heart failure (46.2%) with an increased HR of 2.33 for death (95% CI 1.96 to 2.76; p < 0.001). Greater comorbidity burden conferred increased risk, with HRs adjusted for age, gender, and heart failure of 1.72 (95% CI 1.44 to 2.05), 2.79 (95% CI 2.15 to 3.62), and 2.98 (95% CI 1.74 to 5.10) for those with 1, 2, and 3 or more noncardiac comorbidities, respectively (all p < 0.001).
Conclusions: Age, noncardiac comorbidities, and prior heart failure influence survival outcomes in ICD recipients. These factors should be considered in the care of ICD recipients.
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Abbreviations and Acronyms
| | CI = confidence interval | | HF = heart failure | | HR = hazard ratio | | ICD = implantable cardioverter-defibrillator | | ICD-9 = International Classification of Diseases, version 9 | | ICD-10 = International Classification of Diseases, version 10 | | VF = ventricular fibrillation | | VT = ventricular tachycardia |
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