Key result
A low admission Norton scale score (≤14) was associated with a 33% one-year mortality rate without ICD therapy, compared to 7% in patients with a high score (18-20) (p < 0.0001).
Why the study?
Competing causes of death may limit ICD benefits, prompting the evaluation of the Norton scale as an aid for ICD patient selection.
Does the Norton scale score predict 1-year mortality in patients undergoing ICD implantation?
Cohort (n=695)
No
Does the Norton scale score predict 1-year mortality in patients undergoing ICD implantation?
The Norton scale score is a useful prognostic tool for predicting 1-year mortality in ICD candidates, helping to identify patients who may not benefit from device therapy due to competing risks.
Answers are grounded in this paper and cite their sources.
Norton scale may aid ICD selection in observational data; leaves open need for prospective validation before clinical adoption.
(1) Background: Implantable cardioverter defibrillators (ICDs) have become the standard of care in the prevention of sudden cardiac death, yet studies have shown that competing causes of death may limit ICD benefits. The Norton scale is a pressure ulcer risk score shown to have prognostic value in other fields. The purpose of this study was to assess the use of the Norton scale as an aid for ICD patient selection; (2) Methods: The study was comprised of consecutive patients who underwent defibrillator implantation at Sheba Medical Center between 2008 and 2016. A competing risk analysis was performed to assess the likelihood of death prior to device therapy; (3) Results: 695 patients were included. A total of 59 (8.5%) patients had low admission Norton scale score (ANSS) (≤14), 81 (11.7%) had intermediate ANSS (15−17), and the remainder (79.8%) had high (18−20) ANSS. The cumulative probability of all-cause mortality within one year of ICD implantation in patients with low ANSS was 30%, compared with 20% and 7% among the intermediate- and high-ANSS groups, respectively. Moreover, the one-year mortality rate without ICD therapy in low-ANSS patients was over four-fold compared with that of high-ANSS patients (33% versus 7%, p < 0.0001); (4) Conclusions: The Norton scale could be a useful additional tool in predicting the life expectancy of ICD candidates, thereby improving patient selection.
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Kestin et al. (2022) conducted a cohort in Implantable cardioverter defibrillator (ICD) candidates (n=695). Low admission Norton scale score (≤14) vs. High admission Norton scale score (18-20) was evaluated on One-year mortality rate without ICD therapy (over four-fold, p=< 0.0001). A low admission Norton scale score (≤14) was associated with a 33% one-year mortality rate without ICD therapy, compared to 7% in patients with a high score (18-20) (p < 0.0001).
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