Key result
Current hospitalization for heart failure at the time of primary prevention ICD placement was associated with an increased risk of death at 90 days (OR 2.25; 95% CI 2.02-2.52; P<0.001).
Why the study?
It was not known whether a recent hospitalization for heart failure before primary prevention ICD placement is associated with subsequent outcomes.
Does the timing of primary prevention ICD placement relative to recent heart failure hospitalization affect periprocedural complications, mortality, and readmission in Medicare beneficiaries with HFrEF?
Cohort (n=81,180)
Yes
Does the timing of primary prevention ICD placement relative to recent heart failure hospitalization affect periprocedural complications, mortality, and readmission in Medicare beneficiaries with HFrEF?
Odds Ratio: 2.25 (95% CI 2.02–2.52)
p-value: p=<0.001
Primary prevention ICD placement during or shortly after a heart failure hospitalization is associated with higher periprocedural complications and 90-day mortality compared to placement in stable outpatients.
Recent HF hospitalization before primary prevention ICD was associated with higher periprocedural complications and short-term mortality; leaves open optimal timing for implantation in this population.
BACKGROUND: Landmark studies have demonstrated the safety and efficacy of implantable cardioverter-defibrillators (ICDs) in selected stable ambulatory patients with heart failure (HF) with a reduced ejection fraction receiving optimal medical therapy. It is not known whether a recent hospitalization for HF before ICD placement is associated with subsequent outcomes. METHODS: A post hoc analysis was performed of Medicare beneficiaries enrolled in the National Cardiovascular Data Registry's ICD Registry with a known diagnosis of HF and an ejection fraction ≤35% underdoing a new ICD placement for primary prevention. Patients were grouped based on the timing of ICD placement from the last hospitalization for HF. The association between timing of ICD placement and outcomes was assessed by using multivariable logistic regression models. RESULTS: The final analytic cohort included 81 180 patients undergoing initial ICD placement for primary prevention who were currently hospitalized for HF (n=11 563, 14%), hospitalized for HF within 3 months (n=6252, 8%), or hospitalized for HF >3 months previously or had no previous hospitalizations for HF (n=63 365, 78%). Patients currently or recently hospitalized for HF had a higher unadjusted composite periprocedural complication rate (2.60% versus 1.71% versus 1.25%, P<0.001). After adjusting for potential confounders, patients currently hospitalized for HF were at higher risk for death (odds ratio, 2.25; 95% CI, 2.02-2.52; P <0.001) and all-cause readmission (odds ratio, 1.89; 95% CI, 1.79-1.99; P <0.001) at 90 days. CONCLUSION: Older patients currently or recently hospitalized for HF undergoing initial ICD placement for primary prevention experienced a higher rate of periprocedural complications and were at increased risk of death in comparison with those receiving an ICD without recent HF hospitalization. Additional prospective, real-world, pragmatic, comparative effectiveness studies should be conducted to define the optimal timing of ICD placement.
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Ambrosy et al. (2018) conducted a cohort in Heart failure with reduced ejection fraction (n=81,180). Current hospitalization for heart failure vs. Hospitalization for heart failure >3 months previously or no previous hospitalizations for heart failure was evaluated on death at 90 days (OR 2.25, 95% CI 2.02-2.52, p=<0.001). Current hospitalization for heart failure at the time of primary prevention ICD placement was associated with an increased risk of death at 90 days (OR 2.25; 95% CI 2.02-2.52; P<0.001).
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