Predictors of early mortality in implantable cardioverter-defibrillator recipients.
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.
Stein
Kenneth M
KM
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
Mittal
Suneet
S
Gilliam
F Roosevelt
FR
Gilligan
David M
DM
Zhong
Qian
Q
Kraus
Stacia Merkel
SM
Meyer
Timothy E
TE
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