Predicting defibrillator benefit in patients with cardiac resynchronization therapy: a competing risk study.

Weber, Dorothea; Koller, Michael; Theuns, Dominic; Yap, Sing; Kühne, Michael; Sticherling, Christian; Reichlin, Tobias Roman; Szili-Torok, Tamas; Osswald, Stefan; Schaer, Beat (2019). Predicting defibrillator benefit in patients with cardiac resynchronization therapy: a competing risk study. Heart rhythm, 16(7), pp. 1057-1064. Elsevier 10.1016/j.hrthm.2019.01.033

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BACKGROUND

Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected heart failure patients but decision-making regarding selection of CRT-defibrillator or CRT-pacemaker is an ongoing debate.

OBJECTIVE

Aim was to construct predictive models and scoring systems for "ICD-therapy" and "death without ICD-therapy (prior death)".

METHODS

We pooled two prospective cohorts of CRT-D patients with primary prevention indication and used Fine and Gray models to develop independent prognostic models for time to first ICD-therapy (event of interest) or death without prior ICD-therapy (competing event). We defined CRT-D benefit as a high probability of ICD-therapy combined with moderate/low probability of prior death.

RESULTS

720 patients were included. Median follow-up was 7.2 years, 247 patients died (34%). Cumulative incidence of ICD-therapy/prior death at 5 years was 24%/17%. In multivariable models, higher NYHA classes, diuretic use, and ischemic cardiomyopathy were predictors of ICD-therapy (HR1.89 [1.30-2.75]; 1.91 [1.12-3.24] ; 1.40[1.02-1.92]), but not of prior death. Males with comorbidities (cancer; renal failure; peripheral artery disease, BMI>30) or systolic blood pressure ≤100 were at higher risk of prior death. Higher age was associated with lower risk of ICD-therapy, but higher risk of prior death. A quarter of patients had low predicted benefit from CRT-D implantation using a scoring system for the dual prediction of "appropriate ICD-therapy" and "death without appropriate ICD-therapy.

CONCLUSION

Different factors predict ICD-therapy or prior death in CRT-D patients using competing risk models. Scoring allows identifying patients with predicted low benefit of CRT-D (low chance of ICD-therapy, high chance of prior death).

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Reichlin, Tobias Roman
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1547-5271
Publisher:	Elsevier
Language:	English
Submitter:	Tobias Roman Reichlin
Date Deposited:	15 Apr 2019 17:51
Last Modified:	05 Dec 2022 15:26
Publisher DOI:	10.1016/j.hrthm.2019.01.033
PubMed ID:	30710738
Uncontrolled Keywords:	Cardiac resynchronization therapy (CRT) Competing risk model Implantable cardioverter defibrillator (ICD) Mortality Prediction model
URI:	https://boris.unibe.ch/id/eprint/126348