Competing risk analysis of cause-specific mortality in patients with an implantable cardioverter-defibrillator: The EVADEF cohort study
Background Although implantable cardioverter-defibrillator (ICD) therapy has been evaluated in randomized controlled trials, enrolling highly selected patients, mortality events in ICD patients have received little attention in routine medical care. We sought to assess the 24-month total and cause-s...
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| Veröffentlicht in: | The American heart journal 2009-02, Vol.157 (2), p.391-397.e1 |
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| creator | Marijon, Eloi, MD Trinquart, Ludovic, MSc Otmani, Akli, MD Waintraub, Xavier, MD Kacet, Salem, MD Clémenty, Jacques, MD Chatellier, Gilles, MD, PhD Le Heuzey, Jean-Yves, MD |
| description | Background Although implantable cardioverter-defibrillator (ICD) therapy has been evaluated in randomized controlled trials, enrolling highly selected patients, mortality events in ICD patients have received little attention in routine medical care. We sought to assess the 24-month total and cause-specific mortality rates and their predictors in “real life” patients with an ICD. Methods The Évaluation Médico-Économique du Défibrillateur Automatique Implantable study was a French multicenter, prospective, observational cohort study of ICD patients with a 2-year follow-up. Cause-specific mortality rates and predictors at implantation of sudden cardiac death (SCD) or progressive heart failure (HF) death were assessed using competing risk methodology. Results From June 2001 to June 2003, 2,296 unselected patients were implanted and followed until June 2005. During a mean follow-up of 20.5 ± 6.7 months, 274 deaths occurred: 29 (10.6%) were SCD and 146 (53.3%) were HF deaths, corresponding to 24-month cause-specific mortality rates of 1.4% (95% confidence interval 0.9%-1.9%) and 6.9% (95% confidence interval 5.8%-8.0%), respectively. Among the characteristics at implantation, ejection fraction (EF) |
| doi_str_mv | 10.1016/j.ahj.2008.09.023 |
| format | Article |
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We sought to assess the 24-month total and cause-specific mortality rates and their predictors in “real life” patients with an ICD. Methods The Évaluation Médico-Économique du Défibrillateur Automatique Implantable study was a French multicenter, prospective, observational cohort study of ICD patients with a 2-year follow-up. Cause-specific mortality rates and predictors at implantation of sudden cardiac death (SCD) or progressive heart failure (HF) death were assessed using competing risk methodology. Results From June 2001 to June 2003, 2,296 unselected patients were implanted and followed until June 2005. During a mean follow-up of 20.5 ± 6.7 months, 274 deaths occurred: 29 (10.6%) were SCD and 146 (53.3%) were HF deaths, corresponding to 24-month cause-specific mortality rates of 1.4% (95% confidence interval 0.9%-1.9%) and 6.9% (95% confidence interval 5.8%-8.0%), respectively. Among the characteristics at implantation, ejection fraction (EF) <30% and history of atrial fibrillation were independently associated with SCD; age, high New York Heart Association class, systemic hypertension, prior atrial fibrillation, QRS duration, EF <30%, and lack of β-blocker therapy were independently associated with HF death. Conclusions In this large cohort of “daily” patients, the 2-year incidence of SCD (1.4%) was comparable with the event rate observed in randomized controlled trials; HF remained the predominant mode of death. An EF <30% at implantation appears to be the most important predictor of ICD-unresponsive SCD.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2008.09.023</identifier><identifier>PMID: 19185651</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Arrhythmias, Cardiac - mortality ; Arrhythmias, Cardiac - therapy ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Cause of Death ; Cohort Studies ; Death, Sudden, Cardiac - epidemiology ; Defibrillators, Implantable - adverse effects ; Disease Progression ; Female ; Follow-Up Studies ; Heart attacks ; Heart Failure - mortality ; Humans ; Male ; Medical sciences ; Middle Aged ; Mortality ; Prospective Studies ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Risk Assessment ; Stroke Volume ; Survival Analysis</subject><ispartof>The American heart journal, 2009-02, Vol.157 (2), p.391-397.e1</ispartof><rights>Mosby, Inc.</rights><rights>2009 Mosby, Inc.</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Limited Feb 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-79d5ed000f4fe84d69c20fad5a75430c481e10b7a0f2de1817ecf655f3046d543</citedby><cites>FETCH-LOGICAL-c464t-79d5ed000f4fe84d69c20fad5a75430c481e10b7a0f2de1817ecf655f3046d543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870308008302$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21100330$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19185651$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marijon, Eloi, MD</creatorcontrib><creatorcontrib>Trinquart, Ludovic, MSc</creatorcontrib><creatorcontrib>Otmani, Akli, MD</creatorcontrib><creatorcontrib>Waintraub, Xavier, MD</creatorcontrib><creatorcontrib>Kacet, Salem, MD</creatorcontrib><creatorcontrib>Clémenty, Jacques, MD</creatorcontrib><creatorcontrib>Chatellier, Gilles, MD, PhD</creatorcontrib><creatorcontrib>Le Heuzey, Jean-Yves, MD</creatorcontrib><creatorcontrib>On Behalf of the Évaluation Médico-Économique du Défibrillateur Automatique Implantable (EVADEF) Investigators</creatorcontrib><creatorcontrib>Evaluation Médico-Economique du Défibrillateur Automatique Implantable (EVADEF) Investigators</creatorcontrib><title>Competing risk analysis of cause-specific mortality in patients with an implantable cardioverter-defibrillator: The EVADEF cohort study</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Although implantable cardioverter-defibrillator (ICD) therapy has been evaluated in randomized controlled trials, enrolling highly selected patients, mortality events in ICD patients have received little attention in routine medical care. We sought to assess the 24-month total and cause-specific mortality rates and their predictors in “real life” patients with an ICD. Methods The Évaluation Médico-Économique du Défibrillateur Automatique Implantable study was a French multicenter, prospective, observational cohort study of ICD patients with a 2-year follow-up. Cause-specific mortality rates and predictors at implantation of sudden cardiac death (SCD) or progressive heart failure (HF) death were assessed using competing risk methodology. Results From June 2001 to June 2003, 2,296 unselected patients were implanted and followed until June 2005. During a mean follow-up of 20.5 ± 6.7 months, 274 deaths occurred: 29 (10.6%) were SCD and 146 (53.3%) were HF deaths, corresponding to 24-month cause-specific mortality rates of 1.4% (95% confidence interval 0.9%-1.9%) and 6.9% (95% confidence interval 5.8%-8.0%), respectively. Among the characteristics at implantation, ejection fraction (EF) <30% and history of atrial fibrillation were independently associated with SCD; age, high New York Heart Association class, systemic hypertension, prior atrial fibrillation, QRS duration, EF <30%, and lack of β-blocker therapy were independently associated with HF death. Conclusions In this large cohort of “daily” patients, the 2-year incidence of SCD (1.4%) was comparable with the event rate observed in randomized controlled trials; HF remained the predominant mode of death. An EF <30% at implantation appears to be the most important predictor of ICD-unresponsive SCD.</description><subject>Aged</subject><subject>Arrhythmias, Cardiac - mortality</subject><subject>Arrhythmias, Cardiac - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Death, Sudden, Cardiac - epidemiology</subject><subject>Defibrillators, Implantable - adverse effects</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Heart Failure - mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Prospective Studies</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Risk Assessment</subject><subject>Stroke Volume</subject><subject>Survival Analysis</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9ktGK1DAUhoso7rj6AN5IQPSu9aRt0lZBWMZZFRa8cPU2ZJITJ9226SbpyjyBr22GGVzYC6_Cge__c875T5a9pFBQoPxdX8hdX5QAbQFdAWX1KFtR6JqcN3X9OFsBQJm3DVRn2bMQ-lTysuVPszPa0ZZxRlfZn7UbZ4x2-kW8DTdETnLYBxuIM0TJJWAeZlTWWEVG56McbNwTO5FZRotTDOS3jbukInacBzlFuR0wCb227g59RJ9rNHbr7TDI6Px7cr1Dsvl58WlzSZTbJUsS4qL3z7MnRg4BX5ze8-zH5eZ6_SW_-vb56_riKlc1r2PedJqhToOY2mBba96pEozUTDasrkDVLUUK20aCKTXSljaoDGfMVFBznZDz7O3Rd_budsEQxWiDwtTdhG4JgvO2ocAgga8fgL1bfNpOEJRBzTpgZZMoeqSUdyF4NGL2dpR-LyiIQ0aiFykjcchIQCdSRknz6uS8bEfU94pTKAl4cwJkUHIwXk7Khn9cSSlAVR1a_HDkMC3szqIXQaVQFGrrUUWhnf1vGx8fqNVgJ5s-vME9hvtpRSgFiO-HYzrcErTJpEoOfwHuzMSp</recordid><startdate>20090201</startdate><enddate>20090201</enddate><creator>Marijon, Eloi, MD</creator><creator>Trinquart, Ludovic, MSc</creator><creator>Otmani, Akli, MD</creator><creator>Waintraub, Xavier, MD</creator><creator>Kacet, Salem, MD</creator><creator>Clémenty, Jacques, MD</creator><creator>Chatellier, Gilles, MD, PhD</creator><creator>Le Heuzey, Jean-Yves, MD</creator><general>Mosby, Inc</general><general>Mosby</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20090201</creationdate><title>Competing risk analysis of cause-specific mortality in patients with an implantable cardioverter-defibrillator: The EVADEF cohort study</title><author>Marijon, Eloi, MD ; Trinquart, Ludovic, MSc ; Otmani, Akli, MD ; Waintraub, Xavier, MD ; Kacet, Salem, MD ; Clémenty, Jacques, MD ; Chatellier, Gilles, MD, PhD ; Le Heuzey, Jean-Yves, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-79d5ed000f4fe84d69c20fad5a75430c481e10b7a0f2de1817ecf655f3046d543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Arrhythmias, Cardiac - mortality</topic><topic>Arrhythmias, Cardiac - therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Death, Sudden, Cardiac - epidemiology</topic><topic>Defibrillators, Implantable - adverse effects</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Heart Failure - mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Prospective Studies</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Risk Assessment</topic><topic>Stroke Volume</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marijon, Eloi, MD</creatorcontrib><creatorcontrib>Trinquart, Ludovic, MSc</creatorcontrib><creatorcontrib>Otmani, Akli, MD</creatorcontrib><creatorcontrib>Waintraub, Xavier, MD</creatorcontrib><creatorcontrib>Kacet, Salem, MD</creatorcontrib><creatorcontrib>Clémenty, Jacques, MD</creatorcontrib><creatorcontrib>Chatellier, Gilles, MD, PhD</creatorcontrib><creatorcontrib>Le Heuzey, Jean-Yves, MD</creatorcontrib><creatorcontrib>On Behalf of the Évaluation Médico-Économique du Défibrillateur Automatique Implantable (EVADEF) Investigators</creatorcontrib><creatorcontrib>Evaluation Médico-Economique du Défibrillateur Automatique Implantable (EVADEF) Investigators</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marijon, Eloi, MD</au><au>Trinquart, Ludovic, MSc</au><au>Otmani, Akli, MD</au><au>Waintraub, Xavier, MD</au><au>Kacet, Salem, MD</au><au>Clémenty, Jacques, MD</au><au>Chatellier, Gilles, MD, PhD</au><au>Le Heuzey, Jean-Yves, MD</au><aucorp>On Behalf of the Évaluation Médico-Économique du Défibrillateur Automatique Implantable (EVADEF) Investigators</aucorp><aucorp>Evaluation Médico-Economique du Défibrillateur Automatique Implantable (EVADEF) Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Competing risk analysis of cause-specific mortality in patients with an implantable cardioverter-defibrillator: The EVADEF cohort study</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2009-02-01</date><risdate>2009</risdate><volume>157</volume><issue>2</issue><spage>391</spage><epage>397.e1</epage><pages>391-397.e1</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Although implantable cardioverter-defibrillator (ICD) therapy has been evaluated in randomized controlled trials, enrolling highly selected patients, mortality events in ICD patients have received little attention in routine medical care. We sought to assess the 24-month total and cause-specific mortality rates and their predictors in “real life” patients with an ICD. Methods The Évaluation Médico-Économique du Défibrillateur Automatique Implantable study was a French multicenter, prospective, observational cohort study of ICD patients with a 2-year follow-up. Cause-specific mortality rates and predictors at implantation of sudden cardiac death (SCD) or progressive heart failure (HF) death were assessed using competing risk methodology. Results From June 2001 to June 2003, 2,296 unselected patients were implanted and followed until June 2005. During a mean follow-up of 20.5 ± 6.7 months, 274 deaths occurred: 29 (10.6%) were SCD and 146 (53.3%) were HF deaths, corresponding to 24-month cause-specific mortality rates of 1.4% (95% confidence interval 0.9%-1.9%) and 6.9% (95% confidence interval 5.8%-8.0%), respectively. Among the characteristics at implantation, ejection fraction (EF) <30% and history of atrial fibrillation were independently associated with SCD; age, high New York Heart Association class, systemic hypertension, prior atrial fibrillation, QRS duration, EF <30%, and lack of β-blocker therapy were independently associated with HF death. Conclusions In this large cohort of “daily” patients, the 2-year incidence of SCD (1.4%) was comparable with the event rate observed in randomized controlled trials; HF remained the predominant mode of death. An EF <30% at implantation appears to be the most important predictor of ICD-unresponsive SCD.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>19185651</pmid><doi>10.1016/j.ahj.2008.09.023</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Arrhythmias, Cardiac - mortality Arrhythmias, Cardiac - therapy Biological and medical sciences Cardiac arrhythmia Cardiology. Vascular system Cardiovascular Cardiovascular disease Cause of Death Cohort Studies Death, Sudden, Cardiac - epidemiology Defibrillators, Implantable - adverse effects Disease Progression Female Follow-Up Studies Heart attacks Heart Failure - mortality Humans Male Medical sciences Middle Aged Mortality Prospective Studies Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Risk Assessment Stroke Volume Survival Analysis |
| title | Competing risk analysis of cause-specific mortality in patients with an implantable cardioverter-defibrillator: The EVADEF cohort study |
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