Green Ariel R, Leff Bruce, Wang Yongfei, Spatz Erica S, Masoudi Frederick A, Peterson Pamela N, Daugherty Stacie L, Matlock Daniel D
From the Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine (A.R.G., B.L.); Department of Health Policy and Management, Bloomberg School of Public Health (B.L), Johns Hopkins University Baltimore, MD; Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, MD (B.L.); Section of Cardiovascular Medicine (Y.W., E.S.S.), Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation (Y.W., E.S.S.), Yale/Yale-New Haven Hospital Systems, New Haven, CT; Division of Cardiology, Department of Medicine (F.A.M., P.N.P., S.L.D.) and Division of Geriatrics, Department of Medicine (D.D.M.), University of Colorado, Anschutz Medical Campus, Aurora, CO; Colorado Cardiovascular Outcomes Research Consortium (F.A.M., S.L.D., D.D.M., P.N.P.), Denver, CO; Division of Cardiology, Department of Medicine (P.N.P.), Denver Health Medical Center, Denver, CO.
Circ Cardiovasc Qual Outcomes. 2016 Jan;9(1):23-30. doi: 10.1161/CIRCOUTCOMES.115.002053. Epub 2015 Dec 29.
Geriatric conditions may influence outcomes among patients receiving implantable cardioverter-defibrillators (ICDs). We sought to determine the prevalence of frailty and dementia among older adults receiving primary prevention ICDs and to determine the impact of multimorbidity on mortality within 1 year of ICD implantation.
The cohort included 83 792 Medicare patients from the National Cardiovascular Data Registry ICD Registry who underwent first primary prevention ICD implantation between 2006 and 2009. These data were merged with Medicare analytic files to determine the prevalence of frailty, dementia, and other conditions before ICD implantation, as well as 1-year mortality. A validated claim-based algorithm was used to identify frail patients. Mutually exclusive patterns of chronic conditions were examined. The association of each pattern with 1-year mortality was assessed using logistic regression models adjusted for selected patient characteristics. Approximately 1 in 10 Medicare patients with heart failure receiving a primary prevention ICD had frailty (10%) or dementia (1%). One-year mortality was 22% for patients with frailty, 27% for patients with dementia, and 12% in the overall cohort. Several multimorbidity patterns were associated with high 1-year mortality rates: dementia with frailty (29%), frailty with chronic obstructive pulmonary disease (25%), and frailty with diabetes mellitus (23%). These patterns were present in 8% of the cohort.
More than 10% of Medicare beneficiaries with heart failure receiving primary prevention ICDs have frailty or dementia. These patients had significantly higher 1-year mortality than those with other common chronic conditions. Frailty and dementia should be considered in clinical decision-making and guideline development.
老年疾病可能会影响接受植入式心脏复律除颤器（ICD）患者的治疗结果。我们试图确定接受一级预防ICD的老年人中衰弱和痴呆的患病率，并确定合并症对ICD植入后1年内死亡率的影响。
该队列包括来自国家心血管数据注册中心ICD注册库的83792名医疗保险患者，他们在2006年至2009年间首次接受一级预防ICD植入。这些数据与医疗保险分析文件合并，以确定ICD植入前衰弱、痴呆和其他疾病的患病率，以及1年死亡率。使用经过验证的基于索赔的算法来识别衰弱患者。检查慢性病的相互排斥模式。使用针对选定患者特征进行调整的逻辑回归模型评估每种模式与1年死亡率的关联。接受一级预防ICD的医疗保险心力衰竭患者中，约十分之一患有衰弱（10%）或痴呆（1%）。衰弱患者的1年死亡率为22%，痴呆患者为27%，整个队列的1年死亡率为12%。几种合并症模式与高1年死亡率相关：痴呆合并衰弱（29%）、衰弱合并慢性阻塞性肺疾病（25%）和衰弱合并糖尿病（23%）。这些模式在队列中的占比为8%。
接受一级预防ICD的医疗保险心力衰竭受益人中，超过10%患有衰弱或痴呆。这些患者的1年死亡率明显高于其他常见慢性病患者。在临床决策和指南制定中应考虑衰弱和痴呆因素。
