title: Predictors of early mortality in implantable cardioverter-defibrillator recipients.
abstract: OBJECTIVE
  Multiple trials have shown that implantable cardioverter defibrillators (ICDs) prolong survival in secondary and primary prevention populations. However, in spite of the efficacy of these devices in terminating life-threatening arrhythmias, total mortality remains high.
  
  
  RESULTS
  We evaluated 1703 patients (mean age: 67 +/- 12 years, 82% male) with conventional ICD indications, who were enrolled and followed between 2001 and 2004 at 128 US centres. Patients were followed for up to a year, and vital status was obtained for 1655 patients (97%, median follow-up: 377 days). There were 183 deaths within 1 year of ICD implantation (1-year mortality rate: 16%). Predictors of mortality included a history of atrial fibrillation (AF, P < 0.0001), diabetes (P = 0.0001), failure to use cholesterol-lowering medications (P < 0.001), use of digitalis and derivatives (P < 0.0001), use of diuretics (P < 0.0001), low body mass index (BMI, P < 0.0001), increasing age (P < 0.0001), low left ventricular ejection fraction (P < 0.0001), low activity hours (P < 0.0001), elevated resting heart rate (P = 0.014), low mean arterial pressure (MAP, P = 0.007), and poor functional status (New York Heart Association class, P < 0.0001). In multivariate modelling, AF (P < or = 0.001), diabetes (P = 0.004), BMI (P = 0.001), MAP (P = 0.040), and functional class (P = 0.006) predicted mortality.
  
  
  CONCLUSIONS
  In this population undergoing ICD implantation, poor functional status, low MAP, diabetes, low BMI, and AF were strongly associated with death within a year.
authors.affiliation: Maurice and Corinne Greenberg Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, 520 East 70th Street, Starr-4, New York, NY 10021, USA. kstein@mail.med.cornell.edu
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Stein
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
authors.forename: F Roosevelt
authors.initials: FR
authors.lastname: Gilliam
authors.forename: David M
authors.initials: DM
authors.lastname: Gilligan
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhong
authors.forename: Stacia Merkel
authors.initials: SM
authors.lastname: Kraus
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Meyer
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000401:mortality*; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology