A validated risk model for 1-year mortality after primary prevention implantable cardioverter defibrillator placement: Heart Failure

Objective We sought to determine survival for patients with heart failure after an implantation of an implantable cardioverter defibrillator (ICD) for primary prevention in the United States and to develop a simple model that would predict mortality risk. Background Clinical trials have found that patients with heart failure with a 1-year mortality risk near 20% may not benefit from an ICD. Methods We identified patients from the ICD Registry of the National Cardiovascular Disease Registries who underwent ICD implantation for primary prevention from 2007 to 2009. Two risk scores for mortality were developed in 2 cohorts: one limited to those with a B-type natriuretic peptide (BNP) value and a second for all patients. The scores were obtained from derivation datasets and tested in a validation sets using logistic regression models and classification and regression trees. Results In a primary prevention population with BNP available (18,725) the 6 variables most predictive of 1-year mortality were age greater than or equal to 75, BNP greater than or equal to 700 pg/mL, chronic lung disease, dialysis, blood urea nitrogen greater than or equal to 30 mg/dL, and systolic blood pressure