Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
Cardiology, Worcestershire Royal Hospital, Worcester, Worcestershire, UK.
Open Heart. 2024 Oct 14;11(2):e002574. doi: 10.1136/openhrt-2023-002574.
Most patients who have an implantable cardioverter-defibrillator (ICD) implant do not receive life-prolonging therapy from it. Little research has been undertaken to determine which patients benefit the least from ICD therapy. As patients age and accumulate comorbidities, the risk of death increases and the benefit of ICDs diminishes. We sought to evaluate the impact of comorbidity, frailty, functional status on death with no prior appropriate ICD therapy.
A prospective, multicentre, observational study involving 12 English hospitals was undertaken. Patients were eligible for inclusion for the study if they were scheduled to have a de novo, upgrade to or replacement of a transvenous or subcutaneous ICD or cardiac resynchronisation therapy device and defibrillator (CRT-D). Baseline characteristics were collected. Participants were asked to complete a frailty assessment (Fried score) and a functional status questionnaire (EuroQol 5-Dimension 5-Level (EQ-5D-5L)). The Charlson Comorbidity Index was calculated. Patients were prospectively followed up for 2.5 years. The primary outcome was death with no prior appropriate therapy.
In total, 675 patients were enrolled, mean age 65.7 (IQR 65-75) years. A total of 63 patients (9.5%) died during follow-up, 58 without receiving appropriate ICD therapy. Frailty was present in 86/675 (12.7%) and severe comorbidity in 69/675 (10.2%). Multivariate predictors of death with no appropriate therapy were identified and a risk score comprising frailty, comorbidity, increasing age, estimated glomerular filtration rate and EQ-5D-5L was developed.
Comorbidities, frailty and the EQ-5D-5L score are powerful, independent predictors of death with no prior appropriate therapy in ICD/CRT-D recipients.
大多数植入式心脏复律除颤器（ICD）植入患者并未从中获得延长生命的治疗效果。很少有研究旨在确定哪些患者从 ICD 治疗中获益最小。随着患者年龄的增长和合并症的增加，死亡风险增加，ICD 的获益减少。我们试图评估合并症、虚弱、功能状态对无事先适当 ICD 治疗的死亡的影响。
这是一项前瞻性、多中心、观察性研究，涉及 12 家英国医院。如果患者计划接受新植入、升级或更换经静脉或皮下 ICD 或心脏再同步治疗除颤器（CRT-D），则符合纳入研究的条件。收集基线特征。要求参与者完成虚弱评估（Fried 评分）和功能状态问卷（EuroQol 5 维度 5 级（EQ-5D-5L））。计算 Charlson 合并症指数。前瞻性随访患者 2.5 年。主要结局是无事先适当治疗的死亡。
共有 675 名患者入组，平均年龄 65.7（IQR 65-75）岁。共有 63 名患者（9.5%）在随访期间死亡，其中 58 名未接受适当的 ICD 治疗。675 名患者中有 86 名（12.7%）存在虚弱，69 名（10.2%）存在严重合并症。确定了无适当治疗死亡的多变量预测因素，并开发了包含虚弱、合并症、年龄增长、估计肾小球滤过率和 EQ-5D-5L 的风险评分。
在 ICD/CRT-D 接受者中，合并症、虚弱和 EQ-5D-5L 评分是无事先适当治疗死亡的有力、独立预测因素。
