Association Between Comorbidities and Outcomes in Heart Failure Patients With and Without an Implantable Cardioverter-Defibrillator for Primary Prevention.
Abstract
BACKGROUND: Implantable cardioverter-defibrillator (ICD) therapy is associated with
improved outcomes in patients with heart failure (HF), but whether this association
holds among older patients with multiple comorbid illnesses and worse HF burden remains
unclear. METHODS AND RESULTS: Using the National Cardiovascular Data Registry's ICD
Registry and the Get With The Guidelines-Heart Failure (GWTG-HF) registry linked with
Medicare claims, we examined outcomes associated with primary-prevention ICD versus
no ICD among HF patients aged ≥65 years in clinical practice. We included patients
with an ejection fraction ≤35% who received (ICD Registry) and who did not receive
(GWTG-HF) an ICD. Compared with patients with an ICD, patients in the non-ICD group
were older and more likely to be female and white. In matched cohorts, the 3-year
adjusted mortality rate was lower in the ICD group versus the non-ICD group (46.7%
versus 55.8%; adjusted hazard ratio [HR] 0.76; 95% CI 0.69 to 0.83). There was no
associated difference in all-cause readmission (HR 0.99; 95% CI 0.92 to 1.08) but
a lower risk of HF readmission (HR 0.88; 95% CI 0.80 to 0.97). When compared with
no ICD, ICDs were also associated with better survival in patients with ≤3 comorbidities
(HR 0.77; 95% CI 0.69 to 0.87) and >3 comorbidities (HR 0.77; 95% CI 0.64 to 0.93)
and in patients with no hospitalization for HF (HR 0.75; 95% CI 0.65 to 0.86) and
at least 1 prior HF hospitalization (HR 0.69; 95% CI 0.58 to 0.82). In subgroup analyses,
there were no interactions between ICD and mortality risk for comorbidity burden (P=0.95)
and for prior HF hospitalization (P=0.46). CONCLUSION: Among older HF patients, ICDs
for primary prevention were associated with lower risk of mortality even among those
with high comorbid illness burden and prior HF hospitalization.
Type
Journal articleSubject
agingdefibrillation
heart failure
morbidity
mortality
Age Factors
Aged
Aged, 80 and over
Chi-Square Distribution
Comorbidity
Death, Sudden, Cardiac
Defibrillators, Implantable
Electric Countershock
Female
Heart Failure
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Medicare
Multivariate Analysis
Patient Readmission
Primary Prevention
Propensity Score
Proportional Hazards Models
Protective Factors
Recovery of Function
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Treatment Outcome
United States
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https://hdl.handle.net/10161/15001Published Version (Please cite this version)
10.1161/JAHA.115.002061Publication Info
Khazanie, Prateeti; Hellkamp, Anne S; Fonarow, Gregg C; Bhatt, Deepak L; Masoudi,
Frederick A; Anstrom, Kevin J; ... Al-Khatib, Sana M (2015). Association Between Comorbidities and Outcomes in Heart Failure Patients With and
Without an Implantable Cardioverter-Defibrillator for Primary Prevention. J Am Heart Assoc, 4(8). pp. e002061. 10.1161/JAHA.115.002061. Retrieved from https://hdl.handle.net/10161/15001.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Sana Mustapha Al-Khatib
Professor of Medicine
Dr. Sana M. Al-Khatib is a tenured Professor of Medicine at Duke University Medical
Center, a board-certified clinical electrophysiologist and an experienced clinical
researcher in cardiac arrhythmias. She is currently the Director of the Fellowship
Program at the Duke Clinical Research Institute. As a graduate of the NIH-funded
Clinical Research Training Program, she is one of a few electrophysiologists nationwide
with expertise in quantitative research methods.
Kevin J. Anstrom
Adjunct Professor in the Department of Biostatistics & Bioinformatics
My research interests include clinical trial design, causal inference, coordinating
centers, data monitoring, and pragmatic clinical research.
Lesley H. Curtis
Professor in Population Health Sciences
Lesley H. Curtis is Professor in the Departments of Population Health Sciences and
Medicine in the Duke School of Medicine and was inaugural chair of the Department
of Population Health Sciences. A health services researcher by training, Dr. Curtis
is an expert in the use of health care and Medicare claims data for health services
and clinical outcomes research, and a leader in national data quality efforts. Dr.
Curtis has led the linkage of Medicare claims with seve
Adrian Felipe Hernandez
Duke Health Cardiology Professor
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
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