Key result
Baseline clinical model accurately predicts 10-year survival after primary prevention ICD implantation.
Why the study?
To determine the factors that help predict survival after ICD implantation for primary prevention in clinical practice.
Can baseline demographic and clinical factors accurately predict 10-year survival in patients receiving de novo ICDs for primary prevention?
Cohort (n=5,098)
Yes
Can baseline demographic and clinical factors accurately predict 10-year survival in patients receiving de novo ICDs for primary prevention?
A combination of baseline demographic and clinical factors can accurately predict 10-year survival in patients receiving primary prevention ICDs, which may help identify individuals at risk of long-term mortality.
May aid risk stratification in primary prevention ICD patients; leaves open external validation and outcome impact.
Background: ICD implantation for primary prevention in clinical practice and determine the factors which help predict survival after ICD implant. Methods: ICD for primary prevention in Ontario, Canada from 2007 to 2011 using the Ontario ICD Database housed within ICES. Simple random selection was used to split the population into a derivation and internal validation cohort in a ratio of 2:1. Cox proportional hazards regression was used to determine predictors of interest and predict 10-year survival, model performance was assessed using calibration and validation. Results: In the derivation cohort (n = 3399), mean age was 65.3 years (standard deviation [SD] = 11.0), 664 patients were female (19.5 %) and 2344 patients (69.0 %) had ischemic cardiomyopathy. Ten year survival was 45.7 % (95 % confidence interval [CI] 44.0 %-47.4 %). The final prediction model included age, sex, disease factors (ischemic vs nonischemic cardiomyopathy, left ventricular ejection fraction) and patient factors (symptoms, comorbidities), and biomarkers at the time of ICD assessment. This model had good discrimination and calibration in derivation (0.79, 95 % CI 0.77, 0.81) and validation samples (0.78, 95 % CI 0.76, 0.79). Conclusions: A combination of demographic and clinical factors determined at baseline can be used to predict 10-year survival in patients with implantable cardioverter-defibrillators with good accuracy. Our findings help to identify individuals at risk of long-term mortality and may be useful in targeting future prevention strategies to enhance longevity in this high-risk population.
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Wang et al. (2023) conducted a cohort in Primary prevention implantable cardioverter-defibrillator (ICD) (n=5,098). Implantable cardioverter-defibrillator (ICD) was evaluated on 10-year survival (95% CI 44.0-47.4). A clinical prediction model incorporating baseline demographic and clinical factors accurately predicted 10-year survival after primary prevention ICD implantation (derivation c-statistic 0.79; 95% CI 0.77-0.81).
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