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Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation: a report from the NCDR (National Cardiovascular Data Registry).

Publication ,  Journal Article
Dodson, JA; Reynolds, MR; Bao, H; Al-Khatib, SM; Peterson, ED; Kremers, MS; Mirro, MJ; Curtis, JP; NCDR,
Published in: J Am Coll Cardiol
March 4, 2014

OBJECTIVES: To better inform patients and physicians of the expected risk of adverse events and to assist hospitals' efforts to improve the outcomes of patients undergoing implantable cardioverter-defibrillator (ICD) implantation, we developed and validated a risk model using data from the NCDR (National Cardiovascular Data Registry) ICD Registry. BACKGROUND: ICD prolong life in selected patients, but ICD implantation carries the risk of periprocedural complications. METHODS: We analyzed data from 240,632 ICD implantation procedures between April 1, 2010, and December 31, 2011 in the registry. The study group was divided into a derivation (70%) and a validation (30%) cohort. Multivariable logistic regression was used to identify factors associated with in-hospital adverse events (complications or mortality). A parsimonious risk score was developed on the basis of beta estimates derived from the logistic model. Hierarchical models were then used to calculate risk-standardized complication rates to account for differences in case mix and procedural volume. RESULTS: Overall, 4,388 patients (1.8%) experienced at least 1 in-hospital complication or death. Thirteen factors were independently associated with an increased risk of adverse outcomes. Model performance was similar in the derivation and validation cohorts (C-statistics = 0.724 and 0.719, respectively). The risk score characterized patients into low- and-high risk subgroups for adverse events (≤10 points, 0.3%; ≥30 points, 4.2%). The risk-standardized complication rates varied significantly across hospitals (median: 1.77, interquartile range 1.54, 2.14, 5th/95th percentiles: 1.16/3.15). CONCLUSIONS: We developed a simple model that predicts risk for in-hospital adverse events among patients undergoing ICD placement. This can be used for shared decision making and to benchmark hospital performance.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

March 4, 2014

Volume

63

Issue

8

Start / End Page

788 / 796

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Risk Assessment
  • Research Report
  • Registries
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Female
 

Citation

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Dodson, J. A., Reynolds, M. R., Bao, H., Al-Khatib, S. M., Peterson, E. D., Kremers, M. S., … NCDR, . (2014). Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation: a report from the NCDR (National Cardiovascular Data Registry). J Am Coll Cardiol, 63(8), 788–796. https://doi.org/10.1016/j.jacc.2013.09.079
Dodson, John A., Matthew R. Reynolds, Haikun Bao, Sana M. Al-Khatib, Eric D. Peterson, Mark S. Kremers, Michael J. Mirro, Jeptha P. Curtis, and Jeptha P. NCDR. “Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation: a report from the NCDR (National Cardiovascular Data Registry).J Am Coll Cardiol 63, no. 8 (March 4, 2014): 788–96. https://doi.org/10.1016/j.jacc.2013.09.079.
Dodson JA, Reynolds MR, Bao H, Al-Khatib SM, Peterson ED, Kremers MS, et al. Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation: a report from the NCDR (National Cardiovascular Data Registry). J Am Coll Cardiol. 2014 Mar 4;63(8):788–96.
Dodson, John A., et al. “Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation: a report from the NCDR (National Cardiovascular Data Registry).J Am Coll Cardiol, vol. 63, no. 8, Mar. 2014, pp. 788–96. Pubmed, doi:10.1016/j.jacc.2013.09.079.
Dodson JA, Reynolds MR, Bao H, Al-Khatib SM, Peterson ED, Kremers MS, Mirro MJ, Curtis JP, NCDR. Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation: a report from the NCDR (National Cardiovascular Data Registry). J Am Coll Cardiol. 2014 Mar 4;63(8):788–796.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

March 4, 2014

Volume

63

Issue

8

Start / End Page

788 / 796

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Risk Assessment
  • Research Report
  • Registries
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Female