title: Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators.
abstract: BACKGROUND
  Current guidelines do not recommend implantable cardioverter-defibrillator (ICD) implantation in patients with a life expectancy of <1 year. Better methods are needed for identifying patients at high risk for early mortality despite ICD therapy.
  
  
  OBJECTIVE
  To develop and validate a risk prediction score to identify patients at high risk for death within 1 year despite ICD therapy.
  
  
  METHODS
  Detailed clinical data were collected on a large observational cohort of ICD patients from 3 tertiary care centers. One-third of the patients were randomly selected to form the prediction group (PG) from which a risk score was developed using logistic regression. This score was then applied to the remaining two-thirds of the cohort (validation group [VG]) to assess the risk score's predictive accuracy.
  
  
  RESULTS
  The total cohort included 2717 ICD patients (mean age = 64.6 ± 14.5, male = 77.2%, primary prevention = 74.7%). A simple risk score incorporating peripheral arterial disease, age ≥ 70 years, creatinine ≥ 2.0 mg/dL, and ejection fraction ≤20% (PACE) accurately predicted 1-year mortality in the VG. Patients with a risk score of ≥3 had a >4-fold excess 1-year mortality compared with patients with a risk score of <3 (16.5% vs 3.5%; P <.0001).
  
  
  CONCLUSIONS
  Risk reduction provided by ICD therapy in this cohort is not known given the lack of a control group.
  
  
  CONCLUSIONS
  A simple risk score accurately predicts 1-year mortality in ICD patients, as patients with a PACE risk score of ≥3 are at high risk despite ICD therapy.
authors: Beth Israel Deaconess Medical Center, Boston, Massachusetts 02446, USA. daniel.kramer@alumni.brown.edu
authors: Daniel B
authors: DB
authors: Kramer
authors: Paul A
authors: PA
authors: Friedman
authors: Linda M
authors: LM
authors: Kallinen
authors: Thomas Ben
authors: TB
authors: Morrison
authors: Daniel J
authors: DJ
authors: Crusan
authors: David O
authors: DO
authors: Hodge
authors: Matthew R
authors: MR
authors: Reynolds
authors: Robert G
authors: RG
authors: Hauser
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis