The impact of co-morbidity burden on appropriate implantable cardioverter defibrillator therapy and all-cause mortality: insight from Danish nationwide clinical registers

Anne Christine Ruwald*, Michael Vinther, Gunnar H. Gislason, Jens Brock Johansen, Jens Cosedis Nielsen, Helen Høgh Petersen, Sam Riahi, Christian Jons

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Aims: In a nationwide cohort of primary (PP-ICD) and secondary prevention (SP-ICD) implantable cardioverter defibrillator (ICD) patients, we aimed to investigate the association between co-morbidity burden and risk of appropriate ICD therapy and mortality. Methods and results: We identified all patients >18 years, implanted with first-time PP-ICD (n = 1873) or SP-ICD (n = 2461) in Denmark from 2007 to 2012. Co-morbidity was identified in administrative registers of hospitalization and drug prescription from pharmacies. Co-morbidity burden was defined as the number of pre-existing non-ICD indication-related co-morbidities including atrial fibrillation, diabetes, chronic obstructive pulmonary disease, chronic renal disease, liver disease, cancer, chronic psychiatric disease, and peripheral and/or cerebrovascular disease, and divided into four groups (co-morbidity burden 0, 1, 2, and ≥3). Through Cox models, we assessed the impact of co-morbidity burden on appropriate ICD therapy and mortality. Increasing co-morbidity burden was not associated with increased risk of appropriate therapy, irrespective of implant indication [all hazard ratios (HRs) 1.0–1.4, P = NS]. Using no co-morbidities as reference, increasing co-morbidity burden was associated with increased mortality risk in PP-ICD patients (co-morbidity burden 1, HR 2.1; comorbidity burden 2, HR 3.7; co-morbidity burden ≥3, HR 6.6) (all P < 0.001) and SP-ICD patients (co-morbidity burden 1, HR 2.2; co-morbidity burden 2, HR 3.8; co-morbidity burden ≥3, HR 5.8). With increasing co-morbidity burden, an increasing frequency of patients died without having utilized their device, with 72% PP-ICD and 45% SP-ICD patients with co-morbidity burden ≥3 dying without prior appropriate ICD therapy. Conclusion: Increasing co-morbidity burden was not associated with increased risk of appropriate ICD therapy. With increasing co-morbidity burden, mortality increased, and a higher proportion of patients died, without ever having utilized their device.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Volume19
Issue number3
Pages (from-to)377-386
ISSN1388-9842
DOIs
Publication statusPublished - Mar 2017

Keywords

  • Appropriate ICD therapy
  • Co-morbidity burden
  • Implantable cardioverter defibrillators
  • Implantation rate
  • Mortality
  • Cerebrovascular Disorders/epidemiology
  • Humans
  • Middle Aged
  • Death, Sudden, Cardiac/epidemiology
  • Male
  • Secondary Prevention
  • Pulmonary Disease, Chronic Obstructive/epidemiology
  • Peripheral Vascular Diseases/epidemiology
  • Defibrillators, Implantable
  • Female
  • Registries
  • Renal Insufficiency, Chronic/epidemiology
  • Retrospective Studies
  • Neoplasms/epidemiology
  • Diabetes Mellitus/epidemiology
  • Primary Prevention
  • Comorbidity
  • Proportional Hazards Models
  • Atrial Fibrillation/epidemiology
  • Denmark/epidemiology
  • Mental Disorders/epidemiology
  • Aged
  • Liver Diseases/epidemiology
  • Cohort Studies

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