title: Clinical prediction model for death prior to appropriate therapy in primary prevention implantable cardioverter defibrillator patients with ischaemic heart disease: the FADES risk score.
abstract: OBJECTIVE
  To construct a risk score out of baseline variables to estimate the risk of death without prior implantable cardioverter defibrillator (ICD) in primary prevention ICD patients with ischaemic heart disease.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary care facility in The Netherlands.
  
  
  METHODS
  All patients with ischaemic heart disease who received an ICD for primary prevention of sudden cardiac death at the Leiden University Medical Center, Leiden, The Netherlands in the period 1996-2009.
  
  
  METHODS
  All-cause mortality without prior appropriate ICD therapy (anti-tachycardia pacing or shock).
  
  
  RESULTS
  900 patients (87% men, mean age 64±10 years) were included in the analysis. During a median follow-up of 669 days (IQR 363-1322 days), 150 patients (17%) died and 191 (21%) patients received appropriate device therapy. 114 (13%) patients died without prior appropriate therapy. Stratification of the risk for death without prior appropriate therapy resulted in risk categorisation of patients as low, intermediate or high risk. NYHA ≥III, advanced age, diabetes mellitus, left ventricular ejection fraction ≤25% and a history of smoking were significant independent predictors of death without appropriate ICD therapy. 5-year cumulative incidence for death without prior appropriate therapy ranged from 10% (95% CI 6% to 16%) in low-risk patients to 41% (95% CI 33% to 51%) in high-risk patients.
  
  
  CONCLUSIONS
  The risk of death without prior appropriate ICD therapy can be predicted in primary prevention ICD patients with ischaemic heart disease, which facilitates patient-tailored risk estimation.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. m.j.schalij@lumc.nl
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Rees
authors.forename: C Jan Willem
authors.initials: CJ
authors.lastname: Borleffs
authors.forename: Guido H
authors.initials: GH
authors.lastname: van Welsenes
authors.forename: Enno T
authors.initials: ET
authors.lastname: van der Velde
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Lieselot
authors.initials: L
authors.lastname: van Erven
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.forename: Johanna G
authors.initials: JG
authors.lastname: van der Bom
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
mesh_terms: D017677:Age Distribution; D000368:Aged; D000465:Algorithms; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D058065:Diabetic Cardiomyopathies / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000517:prevention & control* / Q000628:therapy; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D011322:Primary Prevention; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome