title: Prevalence and prognostic impact of comorbidities in heart failure patients with implantable cardioverter defibrillator.
abstract: OBJECTIVE
  This study assessed the prevalence and the prognostic impact of comorbidities in heart failure patients with implantatable cardioverter-defibrillator (ICD).
  
  
  RESULTS
  We prospectively enrolled 146 patients with chronic heart failure, an ICD, and systolic dysfunction (mean ejection fraction 29 +/- 10%). Cardiac death was chosen as the primary endpoint. Death or appropriate ICD therapy, i.e. antitachycardia pacing/shock due to sustained ventricular tachycardia or ventricular fibrillation, was chosen as the secondary endpoint. Seventy-five patients (52%) had chronic kidney disease (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2)), 39 patients (27%) were anaemic, and 34 patients (23%) had diabetes mellitus. During a follow-up of 663 +/- 400 days, 22 patients (15%) died, and 41 patients (28%) received an appropriate ICD therapy. By multivariate Cox analysis, independent predictors of cardiac death were chronic kidney disease, age, and NYHA functional class. Death/appropriate ICD therapy were independently predicted by chronic kidney disease and QRS duration. In the presence of chronic kidney disease, outcome was significantly worse when compared with the absence (event-free survival rate 51 vs. 76%, P < 0.001).
  
  
  CONCLUSIONS
  In heart failure patients with an ICD, comorbidities are frequent but only the presence of chronic kidney disease is independently associated with increased morbidity and mortality.
authors.affiliation: Department of Cardiology and Angiology, Hospital of the University of Münster, Albert-Schweitzer-Str.33, D-48129 Münster, Germany. bruchc@uni-muenster.de
authors.forename: Christian
authors.initials: C
authors.lastname: Bruch
authors.forename: Chahrebanu
authors.initials: C
authors.lastname: Bruch
authors.forename: Jürgen
authors.initials: J
authors.lastname: Sindermann
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Rainer
authors.initials: R
authors.lastname: Gradaus
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000401:mortality* / Q000517:prevention & control*; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014693:Ventricular Fibrillation / Q000401:mortality* / Q000517:prevention & control*