This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.02.058v1 49/25/2408    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lee, D. S. Articles by Laupacis, A. Search for Related Content PubMed PubMed Citation Articles by Lee, D. S. Articles by Laupacis, A. Related Collections Related Articles

CLINICAL RESEARCH: HEART RHYTHM DISORDERS

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
University Health Network
Sunnybrook and Women's Health Sciences Centre
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.

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

Related Articles

Inside this Issue of JACC
J. Am. Coll. Cardiol. 2007 49: A31-A32. [Full Text] [PDF]

This article has been cited by other articles:

				D. R. MacFadden, E. Crystal, A. D. Krahn, I. Mangat, J. S. Healey, P. Dorian, D. Birnie, C. S. Simpson, Y. Khaykin, A. Pinter, et al. Sex Differences in Implantable Cardioverter-Defibrillator Outcomes: Findings From a Prospective Defibrillator Database Ann Intern Med, February 7, 2012; 156(3): 195 - 203. [Abstract] [Full Text] [PDF]

				J. B. van Rees, C. J. Willem Borleffs, J. Thijssen, M. K. de Bie, L. van Erven, S. C. Cannegieter, J. J. Bax, and M. J. Schalij Prophylactic implantable cardioverter-defibrillator treatment in the elderly: therapy, adverse events, and survival gain Europace, January 1, 2012; 14(1): 66 - 73. [Abstract] [Full Text] [PDF]

				R. V. SAMALA, V. NAVAS, E. SALUKE, and J. O. CIOCON Heart failure in frail, older patients: We can do 'MORE' Cleveland Clinic Journal of Medicine, December 1, 2011; 78(12): 837 - 845. [Abstract] [Full Text] [PDF]

				J. Sjoblom, L. Ljung, M. Frick, M. Rosenqvist, and V. Frykman Primary prevention of defibrillator implantation after myocardial infarction: clinical practice and compliance to guidelines Europace, November 23, 2011; (2011) eur354v1. [Abstract] [Full Text] [PDF]

				V. Tsai, M. K. Goldstein, H. H. Hsia, Y. Wang, J. Curtis, P. A. Heidenreich, and on behalf of the National Cardiovascular Data's IC Influence of Age on Perioperative Complications Among Patients Undergoing Implantable Cardioverter-Defibrillators for Primary Prevention in the United States Circ Cardiovasc Qual Outcomes, September 1, 2011; 4(5): 549 - 556. [Abstract] [Full Text] [PDF]

				W. C. Levy and T. Dardas Transplant Complications: The Lesser of 2 Evils J. Am. Coll. Cardiol., August 30, 2011; 58(10): 1042 - 1043. [Full Text] [PDF]

				A. D. Krahn, D. S. Lee, D. Birnie, J. S. Healey, E. Crystal, P. Dorian, C. S. Simpson, Y. Khaykin, D. Cameron, A. Janmohamed, et al. Predictors of Short-Term Complications After Implantable Cardioverter-Defibrillator Replacement: Results From the Ontario ICD Database Circ Arrhythm Electrophysiol, April 1, 2011; 4(2): 136 - 142. [Abstract] [Full Text] [PDF]

				D. A. M. J. Theuns, B. A. Schaer, O. I. I. Soliman, D. Altmann, C. Sticherling, M. L. Geleijnse, S. Osswald, and L. Jordaens The prognosis of implantable defibrillator patients treated with cardiac resynchronization therapy: comorbidity burden as predictor of mortality Europace, January 1, 2011; 13(1): 62 - 69. [Abstract] [Full Text] [PDF]

				R. C. Myles and D. T. Connelly 47 Implantable cardioverter-defibrillators in heart failure Oxford Textbook of Heart Failure, January 1, 2011; 1(1): med-9780199577729-chapter - med-9780199577729-chapter. [Abstract] [Full Text]

				D. A. M. J. Theuns, T. Smith, M. G. M. Hunink, G. H. Bardy, and L. Jordaens Effectiveness of prophylactic implantation of cardioverter-defibrillators without cardiac resynchronization therapy in patients with ischaemic or non-ischaemic heart disease: a systematic review and meta-analysis Europace, November 1, 2010; 12(11): 1564 - 1570. [Abstract] [Full Text] [PDF]

				D. S. Lee, A. D. Krahn, J. S. Healey, D. Birnie, E. Crystal, P. Dorian, C. S. Simpson, Y. Khaykin, D. Cameron, A. Janmohamed, et al. Evaluation of Early Complications Related to De Novo Cardioverter Defibrillator Implantation: Insights From the Ontario ICD Database J. Am. Coll. Cardiol., February 23, 2010; 55(8): 774 - 782. [Abstract] [Full Text] [PDF]

				P. Korantzopoulos, T. Liu, L. Li, J. A. Goudevenos, and G. Li Implantable cardioverter defibrillator therapy in chronic kidney disease: a meta-analysis Europace, November 1, 2009; 11(11): 1469 - 1475. [Abstract] [Full Text] [PDF]

				W. C. Levy, K. L. Lee, A. S. Hellkamp, J. E. Poole, D. Mozaffarian, D. T. Linker, A. P. Maggioni, I. Anand, P. A. Poole-Wilson, D. P. Fishbein, et al. Maximizing Survival Benefit With Primary Prevention Implantable Cardioverter-Defibrillator Therapy in a Heart Failure Population Circulation, September 8, 2009; 120(10): 835 - 842. [Abstract] [Full Text] [PDF]

				R. Tung and C. D. Swerdlow Refining Patient Selection for Primary Prevention Implantable Cardioverter-Defibrillator Therapy: Reeling in a Net Cast Too Widely Circulation, September 8, 2009; 120(10): 825 - 827. [Full Text] [PDF]

				L. G. Tereshchenko, M. N. Faddis, B. J. Fetics, K. E. Zelik, I. R. Efimov, and R. D. Berger Transient Local Injury Current in Right Ventricular Electrogram After Implantable Cardioverter-Defibrillator Shock Predicts Heart Failure Progression J. Am. Coll. Cardiol., August 25, 2009; 54(9): 822 - 828. [Abstract] [Full Text] [PDF]

				K. M. Stein, S. Mittal, F. R. Gilliam, D. M. Gilligan, Q. Zhong, S. M. Kraus, and T. E. Meyer Predictors of early mortality in implantable cardioverter-defibrillator recipients Europace, June 1, 2009; 11(6): 734 - 740. [Abstract] [Full Text] [PDF]

				R. Tung Reply J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1162 - 1163. [Full Text] [PDF]

				P. S. Chan, B. K. Nallamothu, J. A. Spertus, F. A. Masoudi, C. Bartone, D. J. Kereiakes, and T. Chow Impact of Age and Medical Comorbidity on the Effectiveness of Implantable Cardioverter-Defibrillators for Primary Prevention Circ Cardiovasc Qual Outcomes, January 1, 2009; 2(1): 16 - 24. [Abstract] [Full Text] [PDF]

				C. N. Pellegrini, K. Lee, J. E. Olgin, M. P. Turakhia, Z. H. Tseng, R. Lee, N. Badhwar, B. Lee, and P. D. Varosy Impact of advanced age on survival in patients with implantable cardioverter defibrillators Europace, November 1, 2008; 10(11): 1296 - 1301. [Abstract] [Full Text] [PDF]

				A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N. A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF]

				Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF]

				M. T. Koller, B. Schaer, M. Wolbers, C. Sticherling, H. C. Bucher, and S. Osswald Death Without Prior Appropriate Implantable Cardioverter-Defibrillator Therapy: A Competing Risk Study Circulation, April 15, 2008; 117(15): 1918 - 1926. [Abstract] [Full Text] [PDF]

				S. Mittal Selecting Patients for an Implantable Cardioverter-Defibrillator: Can the Genie Be Put Back Into the Bottle? J. Am. Coll. Cardiol., January 22, 2008; 51(3): 297 - 299. [Full Text] [PDF]

				R. F. Redberg Disparities in Use of Implantable Cardioverter-Defibrillators: Moving Beyond Process Measures to Outcomes Data JAMA, October 3, 2007; 298(13): 1564 - 1566. [Full Text] [PDF]

				S. S. Chugh, K. Reinier, and E. C. Stecker Learning From a Real-World Analysis of Implantable Cardioverter-Defibrillator Recipients: Comorbidities Matter J. Am. Coll. Cardiol., June 26, 2007; 49(25): 2416 - 2418. [Full Text] [PDF]