title: Cardiac device therapy in patients with left ventricular dysfunction and heart failure: 'real-world' data on long-term outcomes (mortality, hospitalizations, days alive and out of hospital).
abstract: The impact on long-term outcomes of implantable cardioverter defibrillators (ICDs) and biventricular defibrillators for cardiac resynchronization (CRT-D) devices in 'real world' patients with heart failure (HF) needs to be assessed in terms of clinical effectiveness.
  
  
  
  A registry including consecutive HF patients who underwent a first implant of an ICD (891 patients) or a CRT-D device (709 patients) in 2006-2010 was followed (median 1487 days and 1516 days, respectively), collecting administrative data on survival, all-cause hospitalizations, cardiovascular or HF hospitalizations, and days alive and out of hospital (DAOH). Survival free from death/cardiac transplant was 61.9% and 63.8% at 5 years for ICD and CRT-D patients, respectively. Associated comorbidities (Charlson Comorbidity Index) had a significant impact on death/cardiac transplant, as well as on hospitalizations. The median values of DAOH% were 97.4% for ICD and 97.7% for CRT-D patients, but data were highly skewed, with the lower quartile of DAOH% values including values ranging between 0% and 52.8% for ICD and between 0% and 56.1% for CRT-D patients. Charlson Comorbidity Index was a very strong predictor of DAOH%.
  
  
  
  Patients who were implanted in 'real world' clinical practice with an ICD or a CRT-D device have, on average, a relatively favourable outcome, with a survival of around 62-64% at 5 years, but with an important burden of hospitalizations. Comorbidities, as evaluated by means of the Charlson Comorbidity Index, have a significant impact on outcomes in terms of mortality/heart transplant, hospitalizations and days spent alive and out of hospital.
authors.affiliation: Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy.|Division of Cardiology, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Berti
authors.affiliation: Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy.
authors.forename: Laura Maria Beatrice
authors.initials: LM
authors.lastname: Belotti
authors.affiliation: Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.affiliation: Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.affiliation: Division of Cardiology, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Vincenzo L
authors.initials: VL
authors.lastname: Malavasi
authors.affiliation: Division of Cardiology, S. Maria Nuova Hospital, Reggio Emilia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Bottoni
authors.affiliation: Division of Cardiology, G. da Saliceto Hospital, Piacenza, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Division of Cardiology, Carpi Hospital, Modena, Italy.
authors.forename: Elia
authors.initials: E
authors.lastname: De Maria
authors.affiliation: Division of Cardiology, M. Bufalini Hospital, Cesena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mantovan
authors.affiliation: Division of Cardiology, Parma University Hospital, Parma, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zardini
authors.affiliation: Division of Cardiology, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casali
authors.affiliation: Division of Cardiology, Local Health Unit, Rimini, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marconi
authors.affiliation: Division of Cardiologia, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bandini
authors.affiliation: Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tomasi
authors.affiliation: Division of Cardiology, Hospital of Bentivoglio, Bologna, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Boggian
authors.affiliation: Division of Cardiology, Maggiore Hospital, Bologna, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Barbato
authors.affiliation: Division of Cardiology, Ferrara University Hospital, Ferrara, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Toselli
authors.affiliation: Division of Cardiology, Baggiovara Hospital, Modena, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Zennaro
authors.affiliation: Division of Cardiology, Cento Hospital, Ferrara, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Sassone
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D002423:Cause of Death; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012042:Registries; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000209:etiology / Q000628:therapy
keywords: Cardiac resynchronization therapy; Defibrillators; Epidemiology; Heart failure; Hospitalizations; Outcome