Home > Electrophysiology, Implantable cardioverter-defibrillators > Journal Club 29 February 2012

Journal Club 29 February 2012

Article:


Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators

Presenter

KC

PICO

An observational study in recipients of implantable cardioverter defibrillators to determine correlates of one-year mortality using stepwise logistic

regression. A derivation set was chosen and then a validation set used to assess the goodness of fit of the model.

Population:

Patients receiving implantable cardioverter defibrilllators (new implants)

Intervention

Not applicable

Comparator

Not applicable

Outcome

One-year mortality

Findings
The total cohort included 2717 ICD patients (mean age = 64.6 ± 14.5, male = 77.2%, primary prevention = 74.7%). A simple risk score incorporating peripheral

arterial disease, age ≥ 70 years, creatinine ≥ 2.0 mg/dL, and ejection fraction ≤20% (PACE) accurately predicted 1-year mortality in the VG. Patients with a

risk score of ≥3 had a >4-fold excess 1-year mortality compared with patients with a risk score of ❤ (16.5% vs 3.5%; P <.0001).

Discussion Summary 

  • The paper is hypothesis generating. The issue of trying to develop criteria for futility are laudable from a patient interest and resourcing.
  • The limitations of risk scores were discussed in general, and consistent with other risk scores there was a poor positive predictive value.
  • The selection bias of cardiologists chosing patients who they perceived had reasonable survival had impacts such as narrowing the age range in the patient group. Age appears to have been a forced variable in the stepwise regression model. It was somewhat reassuring that even in the highest risk (from this model) 80% of patients survived one year.
  • Information regarding the appropriate discharge rate would have provided insight into the benefit in the high risk group. A control group without device with same risk score would have also provided insight. Dr. Atherton observed that patients with similar characteristics in the heart failure with LV systolic dysfunction had a 7% annual mortality.

Background Materials

Dr. Karin Chia kindly provided background material for this paper.

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  1. February 29, 2012 at 8:16 pm

    The link at the article title doesn’t work

    • March 1, 2012 at 11:17 am

      Thank you, I have corrected the omission of the hyperlink.

  2. February 29, 2012 at 8:17 pm

    Thanks for the new post. Keep up the good work!

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