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Does the Implantable Cardioverter-Defibrillator Benefit Vary With the Estimated Proportional Risk of Sudden Death in Heart Failure Patients?

Publication ,  Journal Article
Levy, WC; Li, Y; Reed, SD; Zile, MR; Shadman, R; Dardas, T; Whellan, DJ; Schulman, KA; Ellis, SJ; Neilson, M; O'Connor, CM; HFACTION Investigators,
Published in: JACC Clin Electrophysiol
March 2017

BACKGROUND: Prediction of which heart failure patients are most likely to die of sudden death vs. non-sudden death is an important factor in determining who will benefit the most from an ICD. OBJECTIVE: We developed the Seattle Proportional Risk Model (SPRM) to estimate the proportion of total mortality due to sudden death. We prospectively validated the model in HF-ACTION and tested whether the ICD benefit varied with the SPRM. METHODS: Among 2331 patients enrolled, 1947 patients were retained for analysis over a median follow-up of 2.5 years. The SPRM was calculated using age, gender, diabetes, BMI, SBP, EF, NYHA, sodium, creatinine, and digoxin use. RESULTS: ICD use (ICD or CRT-D) was present prior to death in 1204 patients (62%). SPRM was predictive of sudden death vs. non-sudden death in those without an ICD (P=0.002). The hazard ratio representing ICD versus no ICD was 0.63 for all-cause mortality (P=0.0002). The ICD benefit varied with the SPRM for all-cause mortality (P=0.001), with a greater benefit in those with a higher conditional probability of sudden death. CONCLUSIONS: In an ambulatory NYHA II-IV HF population and EF ≤35%, the SPRM was predictive of the proportional risk of sudden vs. non-sudden death. ICDs were associated with a decreased risk of all-cause mortality by 37% and the ICD benefit varied with the SPRM. The SPRM may have utility in risk stratifying patients for a primary prevention ICD.

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Published In

JACC Clin Electrophysiol

DOI

ISSN

2405-500X

Publication Date

March 2017

Volume

3

Issue

3

Start / End Page

291 / 298

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Risk Factors
  • Prospective Studies
  • Primary Prevention
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
 

Citation

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Levy, W. C., Li, Y., Reed, S. D., Zile, M. R., Shadman, R., Dardas, T., … HFACTION Investigators, . (2017). Does the Implantable Cardioverter-Defibrillator Benefit Vary With the Estimated Proportional Risk of Sudden Death in Heart Failure Patients? JACC Clin Electrophysiol, 3(3), 291–298. https://doi.org/10.1016/j.jacep.2016.09.006
Levy, Wayne C., Yanhong Li, Shelby D. Reed, Michael R. Zile, Ramin Shadman, Todd Dardas, David J. Whellan, et al. “Does the Implantable Cardioverter-Defibrillator Benefit Vary With the Estimated Proportional Risk of Sudden Death in Heart Failure Patients?JACC Clin Electrophysiol 3, no. 3 (March 2017): 291–98. https://doi.org/10.1016/j.jacep.2016.09.006.
Levy WC, Li Y, Reed SD, Zile MR, Shadman R, Dardas T, et al. Does the Implantable Cardioverter-Defibrillator Benefit Vary With the Estimated Proportional Risk of Sudden Death in Heart Failure Patients? JACC Clin Electrophysiol. 2017 Mar;3(3):291–8.
Levy, Wayne C., et al. “Does the Implantable Cardioverter-Defibrillator Benefit Vary With the Estimated Proportional Risk of Sudden Death in Heart Failure Patients?JACC Clin Electrophysiol, vol. 3, no. 3, Mar. 2017, pp. 291–98. Pubmed, doi:10.1016/j.jacep.2016.09.006.
Levy WC, Li Y, Reed SD, Zile MR, Shadman R, Dardas T, Whellan DJ, Schulman KA, Ellis SJ, Neilson M, O’Connor CM, HFACTION Investigators. Does the Implantable Cardioverter-Defibrillator Benefit Vary With the Estimated Proportional Risk of Sudden Death in Heart Failure Patients? JACC Clin Electrophysiol. 2017 Mar;3(3):291–298.

Published In

JACC Clin Electrophysiol

DOI

ISSN

2405-500X

Publication Date

March 2017

Volume

3

Issue

3

Start / End Page

291 / 298

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Risk Factors
  • Prospective Studies
  • Primary Prevention
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Heart Failure