Key result
Clinical risk models for primary prevention ICDs predicted competing 1-year incidences of appropriate shock (0.9% to 9.3%) and mortality (0.6% to 17.7%) from the lowest to highest risk groups.
Why the study?
A conceptualized model is needed to understand risk stratification for primary prevention ICDs considering competing risks of appropriate shock versus mortality.
Can clinical variables simultaneously estimate the competing risks of appropriate ICD shock and mortality in patients with LVEF ≤35% referred for primary prevention ICD?
Can clinical variables simultaneously estimate the competing risks of appropriate ICD shock and mortality in patients with LVEF ≤35% referred for primary prevention ICD?
A dual risk stratification model using clinical variables can simultaneously estimate the competing risks of appropriate ICD shock and mortality, providing a framework to identify patients unlikely to benefit from prophylactic ICD implantation.
Answers are grounded in this paper and cite their sources.
May aid primary prevention ICD selection; leaves open prospective validation before practice change.
Background— A conceptualized model may be useful for understanding risk stratification of primary prevention implantable cardioverter defibrillators considering the competing risks of appropriate implantable cardioverter defibrillator shock versus mortality. Methods and Results— In a prospective, multicenter, population-based cohort with left ventricular ejection fraction ≤35% referred for primary prevention implantable cardioverter defibrillator, we developed dual risk stratification models to determine the competing risks of appropriate defibrillator shock versus mortality using a Fine-Gray subdistribution hazard model. Among 7020 patients referred, 3445 underwent defibrillator implant (79.7% men, median, 66 years [25th, 75th: 58–73]). During 5918 person-years of follow-up, appropriate shock occurred in 204 patients (3.6 shocks/100 person-years) and 292 died (4.9 deaths/100 person-years). Competing risk predictors of appropriate shock included nonsustained ventricular tachycardia, atrial fibrillation, serum creatinine concentration, digoxin or amiodarone use, and QRS duration near 130-ms peak. One-year cumulative incidence of appropriate shock was 0.9% in the lowest risk category, and 1.7%, 2.5%, 4.9%, and 9.3% in low, intermediate, high, and highest risk groups, respectively. Hazard ratios for appropriate shock ranged from 4.04 to 7.79 in the highest 3 deciles (all P ≤0.001 versus lowest risk). Cumulative incidence of 1-year death was 0.6%, 1.9%, 3.3%, 6.2%, and 17.7% in lowest, low, intermediate, high, and highest risk groups, respectively. Mortality hazard ratios ranged from 11.48 to 36.22 in the highest 3 deciles (all P <0.001 versus lowest risk). Conclusions— Simultaneous estimation of risks of appropriate shock and mortality can be performed using clinical variables, providing a potential framework for identification of patients who are unlikely to benefit from prophylactic implantable cardioverter defibrillator.
No takes yet. Share an insight, caveat, or question.
Lee et al. (2015) studied this question. Clinical risk models for primary prevention ICDs predicted competing 1-year incidences of appropriate shock (0.9% to 9.3%) and mortality (0.6% to 17.7%) from the lowest to highest risk groups.
Synapse has enriched 10 related papers. Consider them for comparative context: