title: Clinical risk profile score predicts all cause mortality but not implantable cardioverter defibrillator intervention rate in a large unselected cohort of patients with congestive heart failure.
abstract: BACKGROUND
  Primary prophylactic implantable cardioverter defibrillator (ICD) therapy is indicated for patients with reduced left ventricular ejection fraction (LVEF). We aimed to determine if preoperative clinical risk profiling can predict long-term benefit, and if clinical risk scores can be applied and improved in a patient cohort outside the clinical trial setting.
  
  
  METHODS
  Using registry data, 789 patients with reduced LVEF who received ICDs for primary prevention during 2006-2011 were identified (age 64 ± 11 years, 82% men, 63% ischemic etiology, 52% cardiac resynchronization therapy with defibrillator). The patients were divided into three risk groups, based on the presence of baseline clinical risk factors (age >70, QRS duration >120 ms, New York Heart Association class III-IV, atrial fibrillation history, or creatinine >106 μmol/L). Endpoints were all-cause mortality and survival free of adequate ICD therapy.
  
  
  RESULTS
  Mean follow-up was 39 ± 18 months. Annual mortality was 7.6%, and increased with risk group (p < .001). Rates of appropriate antitachycardia pacing and shock therapy were not statistically different between the groups, and ranged from 11%-16% and 6%-14%, respectively. By combining the previous risk score with data on diabetes, a better independent prediction of mortality was achieved; mortality rates then ranged from 11% (low-risk) to 46% (high-risk) (p < .0001).
  
  
  CONCLUSIONS
  Implantable cardioverter defibrillator therapies occur across the spectrum of comorbidities in a population with systolic heart failure. However, all-cause mortality is considerably higher in the group of patients with accumulated risk factors, and using the proposed scoring system can be helpful for the evaluation and risk stratification of the patient prior to making a decision for a primary prophylactic ICD implantation.
authors: Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden.
authors: Johanna
authors: J
authors: Sjöblom
authors: Arrhythmia Clinic, Skåne University Hospital and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors: Rasmus
authors: R
authors: Borgquist
authors: Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors: Fredrik
authors: F
authors: Gadler
authors: Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors: Torbjörn
authors: T
authors: Kalm
authors: Section of Cardiology, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
authors: Lina
authors: L
authors: Ljung
authors: Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden.
authors: Mårten
authors: M
authors: Rosenqvist
authors: Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden.
authors: Viveka
authors: V
authors: Frykman
authors: Arrhythmia Clinic, Skåne University Hospital and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors: Pyotr G
authors: PG
authors: Platonov
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*
keywords: heart failure; implanted cardioverter defibrillator; primary prevention; risk score; sudden cardiac death