Device diagnostics and long-term clinical outcome in patients receiving cardiac resynchronization therapy.
OBJECTIVE
This retrospective analysis sought to develop and validate a model using the measured diagnostic variables in cardiac resynchronization therapy (CRT) devices to predict mortality.


RESULTS
Data used in this analysis came from two CRT studies: Cardiac Resynchronization Therapy Registry Evaluating Patient Response with RENEWAL Family Devices (CRT RENEWAL) (n = 436) and Heart Failure-Heart Rate Variability (HF-HRV) (n = 838). Patients from CRT RENEWAL were used to create a model for risk of death using logistic regression and to create a scoring system that could be used to predict mortality. Results of both the logistic regression and the clinical risk score were validated in a cohort of patients from the HF-HRV study. Diagnostics significantly improved over time post-CRT implant (all P < 0.001) and were correlated with a trend of decreased risk of death. The regression model classified CRT RENEWAL patients into low (2.8%), moderate (6.9%), and high (13.8%) risk of death based on tertiles of their model predicted risk. The clinical risk score classified CRT RENEWAL patients into low (2.8%), moderate (10.1%), and high (13.4%) risk of death based on tertiles of their score. When both the regression model and the clinical risk score were applied to the HF-HRV study, each was able to classify patients into appropriate levels of risk.


CONCLUSIONS
Device diagnostics may be used to create models that predict the risk of death.
Singh
Jagmeet P
JP
Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114-2696, USA. jsingh@partners.org
Rosenthal
Lawrence S
LS
Hranitzky
Patrick M
PM
Berg
Kellie Chase
KC
Mullin
Christopher M
CM
Thackeray
Lisa
L
Kaplan
Andrew
A
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000401:mortality*; D020000:Decision Support Systems, Clinical; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States