Clinical Risk Stratification for Primary Prevention Implantable Cardioverter Defibrillators
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. In a prospective, multicenter, population-based cohor...
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| Veröffentlicht in: | Circulation. Heart failure 2015-09, Vol.8 (5), p.927-937 |
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| creator | Lee, Douglas S Hardy, Judy Yee, Raymond Healey, Jeffrey S Birnie, David Simpson, Christopher S Crystal, Eugene Mangat, Iqwal Nanthakumar, Kumaraswamy Wang, Xuesong Krahn, Andrew D Dorian, Paul Austin, Peter C Tu, Jack V |
| description | 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.
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 |
| doi_str_mv | 10.1161/CIRCHEARTFAILURE.115.002414 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4568903</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1713528135</sourcerecordid><originalsourceid>FETCH-LOGICAL-c429t-7ff5aa491cb87a97188ddaccc7063e94012813c859df6456b958e03715ac34de3</originalsourceid><addsrcrecordid>eNpdUV1LwzAUDaK4Of0LUvDFl858tg2CMOrmBgNlbk8-hDRNNdo1M-kG_nszp0N9Opdz7z33XA4AFwj2EUrQVT6Z5ePhYDYfDSbTxWwYWNaHEFNED0AXcYpignl6uK8z3gEn3r9CmGDG-DHo4ARjmnLcBU95bRqjZB3NjH-LHlsnW1MFojW2iSrrogdnltJ9BNQb3XzRk-Wqlk0ri1pHuXSlsRvtWu2iW12Zwpm6lq11_hQcVbL2-uwbe2AxGs7zcTy9v5vkg2msKOZtnFYVk5JypIoslTxFWVaWUimVwoRoTiHCGSIqY7ysEsqSgrNMQ5IiJhWhpSY9cLPTXa2LpS5VcOlkLVY748JKI_52GvMinu1GBLGMQxIELr8FnH1fa9-KpfFKhzcabddeoBQRtjXBwuj1blQ5673T1f4MgmIbj_gfT2CZ2MUTts9_O93v_uRBPgE-hZCR</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1713528135</pqid></control><display><type>article</type><title>Clinical Risk Stratification for Primary Prevention Implantable Cardioverter Defibrillators</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Lee, Douglas S ; Hardy, Judy ; Yee, Raymond ; Healey, Jeffrey S ; Birnie, David ; Simpson, Christopher S ; Crystal, Eugene ; Mangat, Iqwal ; Nanthakumar, Kumaraswamy ; Wang, Xuesong ; Krahn, Andrew D ; Dorian, Paul ; Austin, Peter C ; Tu, Jack V</creator><creatorcontrib>Lee, Douglas S ; Hardy, Judy ; Yee, Raymond ; Healey, Jeffrey S ; Birnie, David ; Simpson, Christopher S ; Crystal, Eugene ; Mangat, Iqwal ; Nanthakumar, Kumaraswamy ; Wang, Xuesong ; Krahn, Andrew D ; Dorian, Paul ; Austin, Peter C ; Tu, Jack V ; Investigators of the Ontario ICD Database</creatorcontrib><description>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.
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).
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.</description><identifier>ISSN: 1941-3289</identifier><identifier>EISSN: 1941-3297</identifier><identifier>DOI: 10.1161/CIRCHEARTFAILURE.115.002414</identifier><identifier>PMID: 26224792</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Canada - epidemiology ; Death, Sudden, Cardiac - epidemiology ; Death, Sudden, Cardiac - prevention & control ; Defibrillators, Implantable ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Original ; Primary Prevention - methods ; Prospective Studies ; Risk Assessment - methods ; Risk Factors ; Survival Rate - trends ; Tachycardia, Ventricular - mortality ; Tachycardia, Ventricular - therapy</subject><ispartof>Circulation. Heart failure, 2015-09, Vol.8 (5), p.927-937</ispartof><rights>2015 The Authors.</rights><rights>2015 The Authors. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c429t-7ff5aa491cb87a97188ddaccc7063e94012813c859df6456b958e03715ac34de3</citedby><cites>FETCH-LOGICAL-c429t-7ff5aa491cb87a97188ddaccc7063e94012813c859df6456b958e03715ac34de3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26224792$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Douglas S</creatorcontrib><creatorcontrib>Hardy, Judy</creatorcontrib><creatorcontrib>Yee, Raymond</creatorcontrib><creatorcontrib>Healey, Jeffrey S</creatorcontrib><creatorcontrib>Birnie, David</creatorcontrib><creatorcontrib>Simpson, Christopher S</creatorcontrib><creatorcontrib>Crystal, Eugene</creatorcontrib><creatorcontrib>Mangat, Iqwal</creatorcontrib><creatorcontrib>Nanthakumar, Kumaraswamy</creatorcontrib><creatorcontrib>Wang, Xuesong</creatorcontrib><creatorcontrib>Krahn, Andrew D</creatorcontrib><creatorcontrib>Dorian, Paul</creatorcontrib><creatorcontrib>Austin, Peter C</creatorcontrib><creatorcontrib>Tu, Jack V</creatorcontrib><creatorcontrib>Investigators of the Ontario ICD Database</creatorcontrib><title>Clinical Risk Stratification for Primary Prevention Implantable Cardioverter Defibrillators</title><title>Circulation. Heart failure</title><addtitle>Circ Heart Fail</addtitle><description>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.
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).
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.</description><subject>Aged</subject><subject>Canada - epidemiology</subject><subject>Death, Sudden, Cardiac - epidemiology</subject><subject>Death, Sudden, Cardiac - prevention & control</subject><subject>Defibrillators, Implantable</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Primary Prevention - methods</subject><subject>Prospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Survival Rate - trends</subject><subject>Tachycardia, Ventricular - mortality</subject><subject>Tachycardia, Ventricular - therapy</subject><issn>1941-3289</issn><issn>1941-3297</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUV1LwzAUDaK4Of0LUvDFl858tg2CMOrmBgNlbk8-hDRNNdo1M-kG_nszp0N9Opdz7z33XA4AFwj2EUrQVT6Z5ePhYDYfDSbTxWwYWNaHEFNED0AXcYpignl6uK8z3gEn3r9CmGDG-DHo4ARjmnLcBU95bRqjZB3NjH-LHlsnW1MFojW2iSrrogdnltJ9BNQb3XzRk-Wqlk0ri1pHuXSlsRvtWu2iW12Zwpm6lq11_hQcVbL2-uwbe2AxGs7zcTy9v5vkg2msKOZtnFYVk5JypIoslTxFWVaWUimVwoRoTiHCGSIqY7ysEsqSgrNMQ5IiJhWhpSY9cLPTXa2LpS5VcOlkLVY748JKI_52GvMinu1GBLGMQxIELr8FnH1fa9-KpfFKhzcabddeoBQRtjXBwuj1blQ5673T1f4MgmIbj_gfT2CZ2MUTts9_O93v_uRBPgE-hZCR</recordid><startdate>201509</startdate><enddate>201509</enddate><creator>Lee, Douglas S</creator><creator>Hardy, Judy</creator><creator>Yee, Raymond</creator><creator>Healey, Jeffrey S</creator><creator>Birnie, David</creator><creator>Simpson, Christopher S</creator><creator>Crystal, Eugene</creator><creator>Mangat, Iqwal</creator><creator>Nanthakumar, Kumaraswamy</creator><creator>Wang, Xuesong</creator><creator>Krahn, Andrew D</creator><creator>Dorian, Paul</creator><creator>Austin, Peter C</creator><creator>Tu, Jack V</creator><general>Lippincott Williams & Wilkins</general><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>7X8</scope><scope>5PM</scope></search><sort><creationdate>201509</creationdate><title>Clinical Risk Stratification for Primary Prevention Implantable Cardioverter Defibrillators</title><author>Lee, Douglas S ; Hardy, Judy ; Yee, Raymond ; Healey, Jeffrey S ; Birnie, David ; Simpson, Christopher S ; Crystal, Eugene ; Mangat, Iqwal ; Nanthakumar, Kumaraswamy ; Wang, Xuesong ; Krahn, Andrew D ; Dorian, Paul ; Austin, Peter C ; Tu, Jack V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c429t-7ff5aa491cb87a97188ddaccc7063e94012813c859df6456b958e03715ac34de3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Canada - epidemiology</topic><topic>Death, Sudden, Cardiac - epidemiology</topic><topic>Death, Sudden, Cardiac - prevention & control</topic><topic>Defibrillators, Implantable</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Primary Prevention - methods</topic><topic>Prospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Survival Rate - trends</topic><topic>Tachycardia, Ventricular - mortality</topic><topic>Tachycardia, Ventricular - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Douglas S</creatorcontrib><creatorcontrib>Hardy, Judy</creatorcontrib><creatorcontrib>Yee, Raymond</creatorcontrib><creatorcontrib>Healey, Jeffrey S</creatorcontrib><creatorcontrib>Birnie, David</creatorcontrib><creatorcontrib>Simpson, Christopher S</creatorcontrib><creatorcontrib>Crystal, Eugene</creatorcontrib><creatorcontrib>Mangat, Iqwal</creatorcontrib><creatorcontrib>Nanthakumar, Kumaraswamy</creatorcontrib><creatorcontrib>Wang, Xuesong</creatorcontrib><creatorcontrib>Krahn, Andrew D</creatorcontrib><creatorcontrib>Dorian, Paul</creatorcontrib><creatorcontrib>Austin, Peter C</creatorcontrib><creatorcontrib>Tu, Jack V</creatorcontrib><creatorcontrib>Investigators of the Ontario ICD Database</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Douglas S</au><au>Hardy, Judy</au><au>Yee, Raymond</au><au>Healey, Jeffrey S</au><au>Birnie, David</au><au>Simpson, Christopher S</au><au>Crystal, Eugene</au><au>Mangat, Iqwal</au><au>Nanthakumar, Kumaraswamy</au><au>Wang, Xuesong</au><au>Krahn, Andrew D</au><au>Dorian, Paul</au><au>Austin, Peter C</au><au>Tu, Jack V</au><aucorp>Investigators of the Ontario ICD Database</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Risk Stratification for Primary Prevention Implantable Cardioverter Defibrillators</atitle><jtitle>Circulation. Heart failure</jtitle><addtitle>Circ Heart Fail</addtitle><date>2015-09</date><risdate>2015</risdate><volume>8</volume><issue>5</issue><spage>927</spage><epage>937</epage><pages>927-937</pages><issn>1941-3289</issn><eissn>1941-3297</eissn><abstract>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.
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).
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.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>26224792</pmid><doi>10.1161/CIRCHEARTFAILURE.115.002414</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1941-3289 |
| ispartof | Circulation. Heart failure, 2015-09, Vol.8 (5), p.927-937 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Canada - epidemiology Death, Sudden, Cardiac - epidemiology Death, Sudden, Cardiac - prevention & control Defibrillators, Implantable Female Humans Incidence Male Middle Aged Original Primary Prevention - methods Prospective Studies Risk Assessment - methods Risk Factors Survival Rate - trends Tachycardia, Ventricular - mortality Tachycardia, Ventricular - therapy |
| title | Clinical Risk Stratification for Primary Prevention Implantable Cardioverter Defibrillators |
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