Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit: Insights From the DANISH Trial

Søren Lund Kristensen, Wayne C Levy, Ramin Shadman, Jens C Nielsen, Jens Haarbo, Lars Videbæk, Niels E Bruun, Hans Eiskjær, Henrik Wiggers, Axel Brandes, Anna Margrethe Thøgersen, Christian Hassager, Jesper H Svendsen, Dan E Høfsten, Christian Torp-Pedersen, Steen Pehrson, James Signorovitch, Lars Køber, Jens Jakob Thune

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Objectives: This study aims to identify patients with nonischemic heart failure who are more likely to benefit from implantable cardioverter-defibrillator (ICD) implantation by use of established risk prediction models. Background: It has been debated whether an ICD for primary prevention reduces mortality in patients with nonischemic heart failure. Methods: The Seattle Heart Failure Model (SHFM) predicts all-cause mortality whereas the Seattle Proportional Risk Model (SPRM) predicts the proportion of sudden cardiac death (SCD) versus nonsudden death, with a higher score indicating a greater proportion of SCD. We report the effect of ICD implantation on all-cause mortality and SCD, according to median SPRM and SHFM scores in all 1,116 patients enrolled in the DANISH (Danish study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on mortality) trial. Results: Among patients with an SPRM score above the median (n = 558), ICD implantation reduced all-cause mortality (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.43 to 0.94), whereas patients with lower SPRM scores (n = 558) had no effect (HR: 1.08; 95% CI: 0.78 to 1.49, p for interaction = 0.04). The corresponding numbers for SHFM score above and below the median were HR: 0.84; 95% CI: 0.62 to 1.13 and HR: 0.82; 95% CI: 0.53 to 1.28, respectively (p for interaction = 0.980). In 177 patients with upper SPRM/upper SHFM, ICD implantation reduced all-cause mortality (HR: 0.45; 95% CI: 0.25 to 0.80) when compared to 381 patients with lower SPRM/upper SHFM (HR: 1.09; 95% CI: 0.76 to 1.55) (p for interaction <0.001). Conclusions: Nonischemic heart failure patients with high predicted relative likelihood of SCD, as estimated by higher SPRM score, seemed to benefit from ICD implantation. (DANISH [Danish ICD Study in Patients With Ditaled Cardiomyopathy]; NCT00542945)

Original languageEnglish
JournalJ A C C: Heart Failure
Volume7
Issue number8
Pages (from-to)717-724
ISSN2213-1779
DOIs
Publication statusPublished - Aug 2019

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Implantable Defibrillators
Confidence Intervals
Systolic Heart Failure
Primary Prevention
Proportional Hazards Models

Keywords

  • implantable cardioverter-defibrillator
  • nonischemic cardiomyopathy
  • risk prediction

Cite this

Kristensen, S. L., Levy, W. C., Shadman, R., Nielsen, J. C., Haarbo, J., Videbæk, L., ... Thune, J. J. (2019). Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit: Insights From the DANISH Trial. J A C C: Heart Failure, 7(8), 717-724. https://doi.org/10.1016/j.jchf.2019.03.019
Kristensen, Søren Lund ; Levy, Wayne C ; Shadman, Ramin ; Nielsen, Jens C ; Haarbo, Jens ; Videbæk, Lars ; Bruun, Niels E ; Eiskjær, Hans ; Wiggers, Henrik ; Brandes, Axel ; Thøgersen, Anna Margrethe ; Hassager, Christian ; Svendsen, Jesper H ; Høfsten, Dan E ; Torp-Pedersen, Christian ; Pehrson, Steen ; Signorovitch, James ; Køber, Lars ; Thune, Jens Jakob. / Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit : Insights From the DANISH Trial. In: J A C C: Heart Failure. 2019 ; Vol. 7, No. 8. pp. 717-724.
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title = "Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit: Insights From the DANISH Trial",
abstract = "Objectives: This study aims to identify patients with nonischemic heart failure who are more likely to benefit from implantable cardioverter-defibrillator (ICD) implantation by use of established risk prediction models. Background: It has been debated whether an ICD for primary prevention reduces mortality in patients with nonischemic heart failure. Methods: The Seattle Heart Failure Model (SHFM) predicts all-cause mortality whereas the Seattle Proportional Risk Model (SPRM) predicts the proportion of sudden cardiac death (SCD) versus nonsudden death, with a higher score indicating a greater proportion of SCD. We report the effect of ICD implantation on all-cause mortality and SCD, according to median SPRM and SHFM scores in all 1,116 patients enrolled in the DANISH (Danish study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on mortality) trial. Results: Among patients with an SPRM score above the median (n = 558), ICD implantation reduced all-cause mortality (hazard ratio [HR]: 0.63; 95{\%} confidence interval [CI]: 0.43 to 0.94), whereas patients with lower SPRM scores (n = 558) had no effect (HR: 1.08; 95{\%} CI: 0.78 to 1.49, p for interaction = 0.04). The corresponding numbers for SHFM score above and below the median were HR: 0.84; 95{\%} CI: 0.62 to 1.13 and HR: 0.82; 95{\%} CI: 0.53 to 1.28, respectively (p for interaction = 0.980). In 177 patients with upper SPRM/upper SHFM, ICD implantation reduced all-cause mortality (HR: 0.45; 95{\%} CI: 0.25 to 0.80) when compared to 381 patients with lower SPRM/upper SHFM (HR: 1.09; 95{\%} CI: 0.76 to 1.55) (p for interaction <0.001). Conclusions: Nonischemic heart failure patients with high predicted relative likelihood of SCD, as estimated by higher SPRM score, seemed to benefit from ICD implantation. (DANISH [Danish ICD Study in Patients With Ditaled Cardiomyopathy]; NCT00542945)",
keywords = "implantable cardioverter-defibrillator, nonischemic cardiomyopathy, risk prediction",
author = "Kristensen, {S{\o}ren Lund} and Levy, {Wayne C} and Ramin Shadman and Nielsen, {Jens C} and Jens Haarbo and Lars Videb{\ae}k and Bruun, {Niels E} and Hans Eiskj{\ae}r and Henrik Wiggers and Axel Brandes and Th{\o}gersen, {Anna Margrethe} and Christian Hassager and Svendsen, {Jesper H} and H{\o}fsten, {Dan E} and Christian Torp-Pedersen and Steen Pehrson and James Signorovitch and Lars K{\o}ber and Thune, {Jens Jakob}",
note = "Copyright {\circledC} 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "8",
doi = "10.1016/j.jchf.2019.03.019",
language = "English",
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Kristensen, SL, Levy, WC, Shadman, R, Nielsen, JC, Haarbo, J, Videbæk, L, Bruun, NE, Eiskjær, H, Wiggers, H, Brandes, A, Thøgersen, AM, Hassager, C, Svendsen, JH, Høfsten, DE, Torp-Pedersen, C, Pehrson, S, Signorovitch, J, Køber, L & Thune, JJ 2019, 'Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit: Insights From the DANISH Trial', J A C C: Heart Failure, vol. 7, no. 8, pp. 717-724. https://doi.org/10.1016/j.jchf.2019.03.019

Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit : Insights From the DANISH Trial. / Kristensen, Søren Lund; Levy, Wayne C; Shadman, Ramin; Nielsen, Jens C; Haarbo, Jens; Videbæk, Lars; Bruun, Niels E; Eiskjær, Hans; Wiggers, Henrik; Brandes, Axel; Thøgersen, Anna Margrethe; Hassager, Christian; Svendsen, Jesper H; Høfsten, Dan E; Torp-Pedersen, Christian; Pehrson, Steen; Signorovitch, James; Køber, Lars; Thune, Jens Jakob.

In: J A C C: Heart Failure, Vol. 7, No. 8, 08.2019, p. 717-724.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Risk Models for Prediction of Implantable Cardioverter-Defibrillator Benefit

T2 - Insights From the DANISH Trial

AU - Kristensen, Søren Lund

AU - Levy, Wayne C

AU - Shadman, Ramin

AU - Nielsen, Jens C

AU - Haarbo, Jens

AU - Videbæk, Lars

AU - Bruun, Niels E

AU - Eiskjær, Hans

AU - Wiggers, Henrik

AU - Brandes, Axel

AU - Thøgersen, Anna Margrethe

AU - Hassager, Christian

AU - Svendsen, Jesper H

AU - Høfsten, Dan E

AU - Torp-Pedersen, Christian

AU - Pehrson, Steen

AU - Signorovitch, James

AU - Køber, Lars

AU - Thune, Jens Jakob

N1 - Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2019/8

Y1 - 2019/8

N2 - Objectives: This study aims to identify patients with nonischemic heart failure who are more likely to benefit from implantable cardioverter-defibrillator (ICD) implantation by use of established risk prediction models. Background: It has been debated whether an ICD for primary prevention reduces mortality in patients with nonischemic heart failure. Methods: The Seattle Heart Failure Model (SHFM) predicts all-cause mortality whereas the Seattle Proportional Risk Model (SPRM) predicts the proportion of sudden cardiac death (SCD) versus nonsudden death, with a higher score indicating a greater proportion of SCD. We report the effect of ICD implantation on all-cause mortality and SCD, according to median SPRM and SHFM scores in all 1,116 patients enrolled in the DANISH (Danish study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on mortality) trial. Results: Among patients with an SPRM score above the median (n = 558), ICD implantation reduced all-cause mortality (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.43 to 0.94), whereas patients with lower SPRM scores (n = 558) had no effect (HR: 1.08; 95% CI: 0.78 to 1.49, p for interaction = 0.04). The corresponding numbers for SHFM score above and below the median were HR: 0.84; 95% CI: 0.62 to 1.13 and HR: 0.82; 95% CI: 0.53 to 1.28, respectively (p for interaction = 0.980). In 177 patients with upper SPRM/upper SHFM, ICD implantation reduced all-cause mortality (HR: 0.45; 95% CI: 0.25 to 0.80) when compared to 381 patients with lower SPRM/upper SHFM (HR: 1.09; 95% CI: 0.76 to 1.55) (p for interaction <0.001). Conclusions: Nonischemic heart failure patients with high predicted relative likelihood of SCD, as estimated by higher SPRM score, seemed to benefit from ICD implantation. (DANISH [Danish ICD Study in Patients With Ditaled Cardiomyopathy]; NCT00542945)

AB - Objectives: This study aims to identify patients with nonischemic heart failure who are more likely to benefit from implantable cardioverter-defibrillator (ICD) implantation by use of established risk prediction models. Background: It has been debated whether an ICD for primary prevention reduces mortality in patients with nonischemic heart failure. Methods: The Seattle Heart Failure Model (SHFM) predicts all-cause mortality whereas the Seattle Proportional Risk Model (SPRM) predicts the proportion of sudden cardiac death (SCD) versus nonsudden death, with a higher score indicating a greater proportion of SCD. We report the effect of ICD implantation on all-cause mortality and SCD, according to median SPRM and SHFM scores in all 1,116 patients enrolled in the DANISH (Danish study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on mortality) trial. Results: Among patients with an SPRM score above the median (n = 558), ICD implantation reduced all-cause mortality (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.43 to 0.94), whereas patients with lower SPRM scores (n = 558) had no effect (HR: 1.08; 95% CI: 0.78 to 1.49, p for interaction = 0.04). The corresponding numbers for SHFM score above and below the median were HR: 0.84; 95% CI: 0.62 to 1.13 and HR: 0.82; 95% CI: 0.53 to 1.28, respectively (p for interaction = 0.980). In 177 patients with upper SPRM/upper SHFM, ICD implantation reduced all-cause mortality (HR: 0.45; 95% CI: 0.25 to 0.80) when compared to 381 patients with lower SPRM/upper SHFM (HR: 1.09; 95% CI: 0.76 to 1.55) (p for interaction <0.001). Conclusions: Nonischemic heart failure patients with high predicted relative likelihood of SCD, as estimated by higher SPRM score, seemed to benefit from ICD implantation. (DANISH [Danish ICD Study in Patients With Ditaled Cardiomyopathy]; NCT00542945)

KW - implantable cardioverter-defibrillator

KW - nonischemic cardiomyopathy

KW - risk prediction

U2 - 10.1016/j.jchf.2019.03.019

DO - 10.1016/j.jchf.2019.03.019

M3 - Journal article

C2 - 31302052

VL - 7

SP - 717

EP - 724

JO - J A C C: Heart Failure

JF - J A C C: Heart Failure

SN - 2213-1779

IS - 8

ER -