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.

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Citation

Published Version (Please cite this version)

10.1161/JAHA.115.002061

Publication Info

Khazanie, Prateeti, Anne S Hellkamp, Gregg C Fonarow, Deepak L Bhatt, Frederick A Masoudi, Kevin J Anstrom, Paul A Heidenreich, Clyde W Yancy, et al. (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). p. e002061. 10.1161/JAHA.115.002061 Retrieved from https://hdl.handle.net/10161/15001.

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Scholars@Duke

Curtis

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 several large clinical registries and epidemiological cohort studies including the Framingham Heart Study and the Cardiovascular Health Study. Dr. Curtis currently serves as a senior policy advisor at the Food and Drug Administration supporting the Agency’s evidence generation initiative, and is co-PI of the NIH Pragmatic Trials Collaboratory, an NIH initiative to strengthen the national capacity for large-scale research studies embedded in health care delivery.

Areas of expertise: Health Services Research and Health Policy

 

Hernandez

Adrian Felipe Hernandez

Duke Health Cardiology Professor
Al-Khatib

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. Her clinical expertise is in sudden cardiac death prevention, atrial fibrillation and ventricular arrhythmias, and implantable cardiac devices. Her research expertise lies in the design and conduct of clinical trials, outcomes research, and cost-effectiveness analyses. She is a recipient of a National Heart, Lung and Blood Institute’s R-01 grant titled “Implantable Cardioverter Defibrillator Therapy in Patients with Heart Failure” (2009-2013) and of an American Heart Association Career Development Award (2002-2006). She is a Co-Principal Investigator on an NHLBI-funded T-32 Postdoctoral Training in Cardiovascular Clinical Research and is a co-investigator on several NIH-funded projects. She has more than 350 publications in peer-reviewed journals. She has established several collaborative research efforts both within and outside her institution. The goals of these collaborations are to synergize efforts aimed at improving the survival and quality of life of patients at risk for sudden cardiac death and those with atrial and ventricular arrhythmias through clinical trials and outcomes-based research and to evaluate study design and data analysis in order to improve the quality of research done in these arenas. Dr. Al-Khatib is a Senior Associate Editor for Circulation and is on the Editorial Board for Circulation: Arrhythmia and Electrophysiology, Heart Rhythm, Journal of Cardiovascular Electrophysiology, JACC:EP, the Cardiovascular Digital Health Journal, and the American Heart Journal. Dr. Al-Khatib has served on multiple national committees including the Heart Rhythm Society Board of Trustees (current), the Heart Rhythm Society Finance Committee (current), the Heart Rhythm Society Audit Committee (current), the Heart Rhythm Society Health Policy committee (past), the Heart Rhythm Society Legislative subcommittee (past), and the Heart Rhythm Society Program Planning committee (past). She chaired the 2017 AHA/ACC/HRS Guideline for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. 


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