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Yuyun MF, Erqou SA, Peralta AO, Hoffmeister PS, Yarmohammadi H, Echouffo-Tcheugui JB, Martin DT, Joseph J, Singh JP. Ongoing Risk of Ventricular Arrhythmias and All-Cause Mortality at Implantable Cardioverter Defibrillator Generator Change: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol 2021; 14:e009139. [PMID: 33554611 DOI: 10.1161/circep.120.009139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Matthew F Yuyun
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Sebhat A Erqou
- Brown University (S.A.E.), RI.,Providence VA Medical Center (S.A.E.), RI
| | - Adelqui O Peralta
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Peter S Hoffmeister
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University, New York (H.Y.)
| | | | - David T Martin
- Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Brigham and Women's Hospital (D.T.M., J.J.), Boston
| | - Jacob Joseph
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Brigham and Women's Hospital (D.T.M., J.J.), Boston
| | - Jagmeet P Singh
- Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Massachusetts General Hospital (J.P.S.), Boston
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2
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Zoni-Berisso M, Martignani C, Ammendola E, Narducci ML, Caruso D, Miracapillo G, Notarstefano P, Carinci V, Pierantozzi A, Ciaramitaro G, Calò L, Zennaro M, Infusino T, Ferretti C, Sassone B, Licciardello G, Setti S, Terzaghi C, Malacrida M, Biffi M. Mortality after cardioverter-defibrillator replacement: Results of the DECODE survival score index. Heart Rhythm 2020; 18:411-418. [PMID: 33249200 DOI: 10.1016/j.hrthm.2020.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Device replacement is the ideal time to reassess health care goals regarding continuing implantable cardioverter-defibrillator (ICD) therapy. Only few data are available on the decision making at this time. OBJECTIVES The goals of this study were to identify factors associated with poor prognosis at the time of ICD replacement and to develop a prognostic index able to stratify those patients at risk of dying early. METHODS DEtect long-term COmplications after implantable cardioverter-DEfibrillator replacement (DECODE) was a prospective, single-arm, multicenter cohort study aimed at estimating long-term complications in a large population of patients who underwent ICD/cardiac resynchronization therapy - defibrillator replacement. Potential predictors of death were investigated, and all these factors were gathered into a survival score index (SUSCI). RESULTS We included 983 consecutive patients (median age 71 years (63-78)); 750 (76%) were men, 537 (55%) had ischemic cardiomyopathy; 460 (47%) were implanted with cardiac resynchronization therapy - defibrillator. During a median follow-up period of 761 days (interquartile range 628-904 days), 114 patients (12%) died. In multivariate Cox regression analysis, New York Heart Association class III/IV, ischemic cardiomyopathy, body mass index < 26 kg/m2, insulin administration, age ≥ 75 years, history of atrial fibrillation, and hospitalization within 30 days before ICD replacement remained associated with death. The survival score index showed a good discriminatory power with a hazard ratio of 2.6 (95% confidence interval 2.2-3.1; P < .0001). The risk of death increased according to the severity of the risk profile ranging from 0% (low risk) to 47% (high risk). CONCLUSION A simple score that includes a limited set of variables appears to be predictive of total mortality in an unselected real-world population undergoing ICD replacement. Evaluation of the patient's profile may assist in predicting vulnerability and should prompt individualized options, especially for high-risk patients.
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Affiliation(s)
| | - Cristian Martignani
- Institute of Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, Policlinico S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Maria Lucia Narducci
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Caruso
- Padre Antero Micone Hospital, ASL 3 "Genovese", Genova, Italy
| | | | | | | | | | | | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | | | | | | | - Biagio Sassone
- Department of Morphology, Surgery & Experimental Medicine, Division of Cardiology, SS Annunziata Hospital, University of Ferrara, Cento, Ferrara, Italy
| | | | - Sergio Setti
- Padre Antero Micone Hospital, ASL 3 "Genovese", Genova, Italy
| | | | | | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, Policlinico S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Incorporating patients' preference diagnosis in implantable cardioverter defibrillator decision-making: a review of recent literature. Curr Opin Cardiol 2018; 33:42-49. [PMID: 29216014 DOI: 10.1097/hco.0000000000000464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Strong recommendations exist for implantable cardioverter defibrillators (ICD) in appropriately selected patients. Yet, patient preferences are not often incorporated when decisions about ICD therapy are made. Literature published since 2016 was reviewed aiming to discuss current advances and ongoing challenges with ICD decision-making in adults, discuss shared decision-making (SDM) as a strategy to incorporate preference diagnoses, summarize current evidence on effective interventions to facilitate SDM, and identify opportunities for research and practice. RECENT FINDINGS Advances in risk stratification can identify patients who will most and least likely benefit from the ICD. Interventions to support SDM are emerging. These interventions present options, the risks, and the benefits of each option, and elicit patients' values and preferences regarding possible outcomes. SUMMARY Appropriate patient selection for initial or continued ICD therapy is multifactorial. It requires accurate clinical diagnosis using careful risk stratification and accurate preference diagnosis based upon the patient's preferences. SDM aims to unite the elements that constitute these two equally important diagnoses. High-quality decision-making will be difficult to achieve if patients lack or misunderstand information, and if evolving patient preferences are not incorporated when making decisions.
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Stazi F. End-of-life of implantable defibrillator: are we certain it should always be replaced? J Cardiovasc Med (Hagerstown) 2018. [PMID: 29538158 DOI: 10.2459/jcm.0000000000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Filippo Stazi
- Cardiology Unit, San Giovanni-Addolorata Hospital, Rome, Italy
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