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Seattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators
University of Virginia Health Syst, VA USA.
Yale New Haven Medical Centre, CT 06504 USA; Yale University, CT USA.
Johns Hopkins Medical Institute, MD 21205 USA.
Yale New Haven Medical Centre, CT 06504 USA; Yale University, CT USA.
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2017 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 69, no 21, 2606-2618 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Recent clinical trials highlight the need for better models to identify patients at higher risk of sudden death. OBJECTIVES The authors hypothesized that the Seattle Heart Failure Model (SHFM) for overall survival and the Seattle Proportional Risk Model (SPRM) for proportional risk of sudden death, including death from ventricular arrhythmias, would predict the survival benefit with an implantable cardioverter-defibrillator (ICD). METHODS Patients with primary prevention ICDs from the National Cardiovascular Data Registry (NCDR) were compared with control patients with heart failure (HF) without ICDs with respect to 5-year survival using multivariable Cox proportional hazards regression. RESULTS Among 98,846 patients with HF (87,914 with ICDs and 10,932 without ICDs), the SHFM was strongly associated with all-cause mortality (p amp;lt; 0.0001). The ICD-SPRM interaction was significant (p amp;lt; 0.0001), such that SPRM quintile 5 patients had approximately twice the reduction in mortality with the ICD versus SPRM quintile 1 patients (adjusted hazard ratios [HR]: 0.602; 95% confidence interval [CI]: 0.537 to 0.675 vs. 0.793; 95% CI: 0.736 to 0.855, respectively). Among patients with SHFM-predicted annual mortality amp;lt;= 5.7%, those with a SPRM-predicted risk of sudden death below the median had no reduction in mortality with the ICD (adjusted ICD HR: 0.921; 95% CI: 0.787 to 1.08; p = 0.31), whereas those with SPRM above the median derived the greatest benefit (adjusted HR: 0.599; 95% CI: 0.530 to 0.677; p amp;lt; 0.0001). CONCLUSIONS The SHFM predicted all-cause mortality in a large cohort with and without ICDs, and the SPRM discriminated and calibrated the potential ICD benefit. Together, the models identified patients less likely to derive a survival benefit from primary prevention ICDs. (J Am Coll Cardiol 2017;69:2606-18) (C) 2017 by the American College of Cardiology Foundation.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2017. Vol. 69, no 21, 2606-2618 p.
Keyword [en]
heart failure; implantable cardioverter-defibrillator; risk models
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-138236DOI: 10.1016/j.jacc.2017.03.568ISI: 000401695900005PubMedID: 28545633OAI: oai:DiVA.org:liu-138236DiVA: diva2:1109389
Note

Funding Agencies|Thoratec (St. Jude Medical); HeartWare (Medtronic); GE Healthcare; Athena Health; National Institutes of Health [R03 HL135463]; National Cardiovascular Data Registry; National Institute on Aging [K23AG048331]; American Federation for Aging Research through the Paul B. Beeson Career Development Award Program; Yale Claude D. Pepper Older Americans Independence Center [P30AG021342]; Centers for Medicare & Medicaid Services; Boston Scientific; AstraZeneca; Novartis; Servier; Amgen; Resmed

Available from: 2017-06-14 Created: 2017-06-14 Last updated: 2017-06-14

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Dahlström, Ulf
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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