8
|
Maron BJ, Casey SA, Olivotto I, Sherrid MV, Semsarian C, Autore C, Ahmed A, Boriani G, Francia P, Winters SL, Giudici M, Koulova A, Garberich R, Rowin EJ, Sears SF, Maron MS, Spirito P. Clinical Course and Quality of Life in High-Risk Patients With Hypertrophic Cardiomyopathy and Implantable Cardioverter-Defibrillators. Circ Arrhythm Electrophysiol 2019; 11:e005820. [PMID: 29625970 DOI: 10.1161/circep.117.005820] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND High-risk patients with hypertrophic cardiomyopathy (HCM) are identified by contemporary risk stratification and effectively treated with implantable cardioverter-defibrillators (ICDs). However, long-term HCM clinical course after ICD therapy for ventricular tachyarrhythmias is incompletely understood. METHODS AND RESULTS Cohort of 486 high-risk HCM patients with ICDs was assembled from 8 international centers. Clinical course and device interventions were addressed, and survey questionnaires assessed patient anxiety level and psychological well-being related to ICD therapy. Of 486 patients, 94 (19%) experienced appropriate ICD interventions terminating ventricular tachycardia/ventricular fibrillation, 3.7% per year for primary prevention, over 6.4±4.7 years. Of 94 patients, 87 were asymptomatic or only mildly symptomatic at the time of appropriate ICD interventions; 74 of these 87 (85%) remained in classes I/II without significant change in clinical status over the subsequent 5.9±4.9 years (up to 22). Among the 94 patients, there was one sudden death (caused by device failure; 1.1%); 3 patients died from other HCM-related processes unrelated to arrhythmic risk (eg, end-stage heart failure). Post-ICD intervention, freedom from HCM mortality was 100%, 97%, and 92% at 1, 5, and 10 years, distinctly lower than in ischemic or nonischemic cardiomyopathy ICD trials. HCM patients with ICD interventions reported heightened anxiety in expectation of future shocks, but with intact general psychological well-being and quality of life. CONCLUSIONS In HCM, unlike ischemic heart disease, prevention of sudden death with ICD therapy is unassociated with significant increase in cardiovascular morbidity or mortality, or transformation to heart failure deterioration. ICD therapy does not substantially impair overall psychological and physical well-being.
Collapse
Affiliation(s)
- Barry J Maron
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.).
| | - Susan A Casey
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Iacopo Olivotto
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Mark V Sherrid
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Christopher Semsarian
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Camillo Autore
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Aisha Ahmed
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Giuseppe Boriani
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Pietro Francia
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Stephen L Winters
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Michael Giudici
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Anna Koulova
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Ross Garberich
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Ethan J Rowin
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Samuel F Sears
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Martin S Maron
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| | - Paolo Spirito
- HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA (B.J.M., E.J.R., M.S.M.); Department of Psychology & Cardiovascular Sciences, East Carolina University, Greenville, NC (S.F.S.); Royal Prince Alfred Hospital and Centenary Institute, University of Sydney, Australia (C.S.); Minneapolis Heart Institute Foundation, MN (S.A.C., A.A., R.G.); University of Iowa Hospitals, Iowa City (M.G.); Division of Cardiology, Department of Clinical & Molecular Medicine, Sant' Andrea Hospital, University of Sapienza, Rome (C.A., P.F.); Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena, and Reggio Emilia, Policlinico di Modena, Italy (G.B.); Policlinico di Monza, Italy (P.S.); St. Lukes - Roosevelt Hospital Center, NYU Lan gone Medical Center (M.V.S., A.K.); Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.); Atlantic Health Systems, Morristown Memorial Hospital and Medical Center, NJ (S.L.W.)
| |
Collapse
|
10
|
Hajduk AM, Gurwitz JH, Tabada G, Masoudi FA, Magid DJ, Greenlee RT, Sung SH, Cassidy-Bushrow AE, Liu TI, Reynolds K, Smith DH, Fiocchi F, Goldberg R, Gill TM, Gupta N, Peterson PN, Schuger C, Vidaillet H, Hammill SC, Allore H, Go AS. Influence of Multimorbidity on Burden and Appropriateness of Implantable Cardioverter-Defibrillator Therapies. J Am Geriatr Soc 2019; 67:1370-1378. [PMID: 30892695 DOI: 10.1111/jgs.15839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/25/2019] [Accepted: 01/26/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether burden of multiple chronic conditions (MCCs) influences the risk of receiving inappropriate vs appropriate device therapies. DESIGN Retrospective cohort study. SETTING Seven US healthcare delivery systems. PARTICIPANTS Adults with left ventricular systolic dysfunction receiving an implantable cardioverter-defibrillator (ICD) for primary prevention. MEASUREMENTS Data on 24 comorbid conditions were captured from electronic health records and categorized into quartiles of comorbidity burden (0-3, 4-5, 6-7 and 8-16). Incidence of ICD therapies (shock and antitachycardia pacing [ATP] therapies), including appropriateness, was collected for 3 years after implantation. Outcomes included time to first ICD therapy, total ICD therapy burden, and risk of inappropriate vs appropriate ICD therapy. RESULTS Among 2235 patients (mean age = 69 ± 11 years, 75% men), the median number of comorbidities was 6 (interquartile range = 4-8), with 98% having at least two comorbidities. During a mean 2.2 years of follow-up, 18.3% of patients experienced at least one appropriate therapy and 9.9% experienced at least one inappropriate therapy. Higher comorbidity burden was associated with an increased risk of first inappropriate therapy (adjusted hazard ratio [HR] = 1.94 [95% confidence interval {CI} = 1.14-3.31] for 4-5 comorbidities; HR = 2.25 [95% CI = 1.25-4.05] for 6-7 comorbidities; and HR = 2.91 [95% CI = 1.54-5.50] for 8-16 comorbidities). Participants with 8-16 comorbidities had a higher total burden of ICD therapy (adjusted relative risk [RR] = 2.12 [95% CI = 1.43-3.16]), a higher burden of inappropriate therapy (RR = 3.39 [95% CI = 1.67-6.86]), and a higher risk of receiving inappropriate vs appropriate therapy (RR = 1.74 [95% CI = 1.07-2.82]). Comorbidity burden was not significantly associated with receipt of appropriate ICD therapies. Patterns were similar when separately examining shock or ATP therapies. CONCLUSIONS In primary prevention ICD recipients, MCC burden was independently associated with an increased risk of inappropriate but not appropriate device therapies. Comorbidity burden should be considered when engaging patients in shared decision making about ICD implantation.
Collapse
Affiliation(s)
- Alexandra M Hajduk
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts
| | - Grace Tabada
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Frederick A Masoudi
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David J Magid
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Robert T Greenlee
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Taylor I Liu
- Department of Cardiac Electrophysiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - David H Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Frances Fiocchi
- National Cardiovascular Data Registry, American College of Cardiology Foundation, Washington, DC
| | - Robert Goldberg
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts
| | - Thomas M Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Nigel Gupta
- Department of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Pamela N Peterson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Claudio Schuger
- Heart and Vascular Institute, Henry Ford Health System, Detroit, Michigan
| | - Humberto Vidaillet
- Marshfield Clinical Research Foundation, Marshfield Clinic, Marshfield, Wisconsin
| | | | - Heather Allore
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, California.,Departments of Medicine, Health Research and Policy, Stanford University School of Medicine, Palo Alto, California
| | | |
Collapse
|