School of Population Health, University of Western Australia, Perth, Western Australia.
Am Heart J. 2013 May;165(5):816-22. doi: 10.1016/j.ahj.2013.02.007. Epub 2013 Mar 19.
Automated implantable cardioverter-defibrillators (ICDs) have become standard therapy for patients at high risk for sudden cardiac death. Linked data allow examination of trends in use and long-term survival after ICD implantation in an adult population.
Linked state-wide person-based data on hospital admissions and deaths from 1980 to 2009 were used to identify incident cases of ICD implantation. Population rates were calculated using census data. Kaplan-Meier techniques were used to describe cumulative survival. Cox regression models were used to determine the factors associated with the outcomes.
Between 1988 and 2009, 1593 devices were implanted in patients in Western Australia, rising from 2 in 1988 to 245 in 2009; standardized population rates rose from 0.8 in 100000 in 1995 to 14.9 in 100000 in 2009. Mean age rose from 52.6 (SD 11.6) to 64.1 (11.4) years. Ventricular tachycardia (23%), cardiomyopathy (18%), and heart failure (16%) were the most frequent principal diagnoses. Ischemic heart disease was present in 49% of patients. Five-year cumulative survival was 0.74 (SE 0.01), and at 10 years, 0.53 (SE 0.03); median survival was 11.3 years. Readmission within a year, older age, heart failure, device complications, and chronic ischemic heart disease were associated with poorer survival.
Implantable cardioverter-defibrillator use in adults at risk for sudden cardiac death has grown rapidly. Readmission within 12 months of discharge is associated with worse medium and long-term mortality. Survival for most patients younger than 65 years exceeds 10 years and 5 years for those aged ≥75 years.
自动植入式心脏除颤器（ICD）已成为高危心源性猝死患者的标准治疗方法。关联数据允许检查在成人人群中 ICD 植入后的使用趋势和长期生存率。
使用 1980 年至 2009 年全州范围内的住院和死亡人员关联数据，确定 ICD 植入的病例。使用人口普查数据计算人口率。采用 Kaplan-Meier 技术描述累积生存率。采用 Cox 回归模型确定与结局相关的因素。
1988 年至 2009 年间，西澳大利亚州共植入了 1593 台设备，从 1988 年的 2 台增加到 2009 年的 245 台；标准化人口率从 1995 年的每 10 万人 0.8 上升到 2009 年的每 10 万人 14.9。平均年龄从 52.6（11.6）岁增加到 64.1（11.4）岁。室性心动过速（23%）、心肌病（18%）和心力衰竭（16%）是最常见的主要诊断。5 年累积生存率为 0.74（SE 0.01），10 年生存率为 0.53（SE 0.03）；中位生存期为 11.3 年。出院后 1 年内再入院、年龄较大、心力衰竭、器械并发症和慢性缺血性心脏病与生存率较差相关。
高危心源性猝死的成人患者中，植入式心脏除颤器的使用迅速增加。出院后 12 个月内再入院与中、长期死亡率较高相关。大多数年龄小于 65 岁的患者的生存率超过 10 年，年龄大于 75 岁的患者的生存率超过 5 年。
