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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

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