Key result
Following outpatient ICD implantation, 1-year event-free survival was 80.1%, with age ≥65, male sex, and prior hospitalization significantly predicting adverse outcomes.
Why the study?
What are the risk factors for one-year mortality and complications following outpatient ICD placement in a Medicare Advantage population?
Cohort (n=8,450)
What are the risk factors for one-year mortality and complications following outpatient ICD placement in a Medicare Advantage population?
In an older Medicare Advantage population, most patients do not experience adverse outcomes in the year following outpatient ICD implantation, though older age, male sex, and greater comorbidity burden predict higher mortality.
Claims data may refine post-ICD risk stratification in Medicare patients; leaves open whether targeting these factors improves outcomes.
BACKGROUND: Recipients of ICD are likely to have several risk factors that could interfere with successful use of implantable cardioverter defibrillators (ICDs). HYPOTHESIS: Age, sex, and factors indicated in claims are associated with one-year mortality and complications after ICD placement. METHODS: Adult Medicare Advantage patients who underwent outpatient ICD implantation from January 2014 to September 2015 were included. Age, sex, Charlson Comorbidity Index (CCI), prior year hospitalization and emergency department (ED) visit, diabetes, heart failure, ischemic heart disease, and indicators of the need for pacing were evaluated as risk factors. Mortality and device-related complications (lead and nonlead) were assessed at one-year post-procedure using Kaplan-Meier and Cox Proportional Hazard analysis. RESULTS: Among 8450 patients who underwent implantation, 1-year event-free survival was 80.1%, based on an overall composite measure of complications and mortality. Adjusted survival analysis showed that age ≥ 65, male sex, incremental increase in CCI, heart failure, prior year hospitalization, ED visit, and prior year pacing procedure were significant predictors of mortality. Age ≥ 65, male sex, and prior year hospitalization were significant predictors of a composite measure of device-related complications. CCI and prior hospitalization were significant predictors of a composite measure of any adverse outcome. CONCLUSIONS: Results suggest most patients in an older population do not experience adverse outcomes in the year following ICD implantation. The risk of mortality may be greater in men, patients over the age of 65, and patients with greater general morbidity, heart failure, or a history of a pacing procedure.
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Rogstad et al. (2018) conducted a cohort in Implantable cardioverter defibrillator (ICD) placement (n=8,450). Outpatient implantable cardioverter defibrillator (ICD) placement and associated risk factors was evaluated on 1-year event-free survival based on an overall composite measure of complications and mortality. Following outpatient ICD implantation, 1-year event-free survival was 80.1%, with age ≥65, male sex, and prior hospitalization significantly predicting adverse outcomes.
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