{"id":4269,"date":"2015-07-29T00:00:00","date_gmt":"2015-07-29T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/clinical-risk-stratification-for-primary-prevention-implantable-cardioverter-defibrillators\/"},"modified":"2023-06-14T19:32:48","modified_gmt":"2023-06-14T23:32:48","slug":"clinical-risk-stratification-for-primary-prevention-implantable-cardioverter-defibrillators","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/clinical-risk-stratification-for-primary-prevention-implantable-cardioverter-defibrillators\/","title":{"rendered":"Clinical risk stratification for primary prevention implantable cardioverter defibrillators"},"content":{"rendered":"<p><strong>Background<\/strong> &#x2014; A conceptualized model may be useful for understanding risk stratification of primary prevention implantable cardioverter defibrillators (ICDs) considering the competing risks of appropriate ICD shock vs mortality.<\/p>\n<p><span class=\"bold\">Methods and Results<\/span> &#x2014; In a prospective, multicenter, population-based cohort with left ventricular ejection fraction (LVEF) &#x2264;35% referred for primary prevention ICD, we developed dual risk stratification models to determine the competing risks of appropriate defibrillator shock versus mortality using a Fine-Gray subdistribution hazard model. Among 7020 patients referred, 3445 underwent defibrillator implant (79.7% men, median 66 years [25<sup>th<\/sup>, 75<sup>th<\/sup>: 58-73]). During 5918 person-years of follow-up, appropriate shock occurred in 204 patients (3.6 shocks\/100 person-years) and 292 died (4.9 deaths\/100 person-years). Competing risk predictors of appropriate shock included nonsustained ventricular tachycardia, atrial fibrillation, serum creatinine concentration, digoxin or amiodarone use, and QRS duration near 130-millisecond peak. One-year cumulative incidence of appropriate shock was 0.9% in the lowest-risk category, and 1.7%, 2.5%, 4.9%, and 9.3% in low, intermediate, high, and highest-risk groups, respectively. Hazard ratios for appropriate shock ranged from 4.04 to 7.79 in the highest three deciles (all p &#x2264;.001 vs lowest-risk). Cumulative incidence of one-year death was 0.6%, 1.9%, 3.3%, 6.2%, and 17.7% in lowest, low, intermediate, high, and highest-risk groups, respectively. Mortality hazard ratios ranged from 11.48 to 36.22 in the highest three deciles (all p &lt;.001 vs lowest-risk).<\/p>\n<p><strong>Conclusions<\/strong> &#x2014; Simultaneous estimation of risks of appropriate shock and mortality can be performed using clinical variables, providing a potential framework for identification of patients who are unlikely to benefit from prophylactic ICD.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; A conceptualized model may be useful for understanding risk stratification of primary prevention implantable cardioverter defibrillators (ICDs) considering the competing risks of appropriate ICD shock vs mortality. Methods and Results &#x2014; In a prospective, multicenter, population-based cohort with left ventricular ejection fraction (LVEF) &#x2264;35% referred for primary prevention ICD, we developed dual risk [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[40,35],"migration-helper-qa-sample-set":[],"class_list":["post-4269","journal_article","type-journal_article","status-publish","hentry","topic-cardiovascular-disease","topic-public-health"],"acf":{"citation":"Lee DS, Hardy J, Yee R, Healey JS, Birnie D, Simpson CS, Crystal E, Mangat I, Nanthakumar K, Wang X, Krahn AD, Dorian P, Austin PC, Tu JV; Investigators of the Ontario ICD Database. <em>Circ Heart Fail<\/em>. 2015; 8(5):927-37. Epub 2015 Jul 29.","source_url":"https:\/\/www.ahajournals.org\/doi\/abs\/10.1161\/CIRCHEARTFAILURE.115.002414","ices_scientist":[1290,1363,1385],"site":[6733,6736,6735],"research_program":[6742,6746],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"308C1470-E8E0-4A9D-8AD5-42E91865DBE5","sitecore_item_name":"Clinical-risk-stratification-for-primary-prevention-implantable-cardioverter-defibrillators","sitecore_field_values":"{\n  \"Title\": \"Clinical risk stratification for primary prevention implantable cardioverter defibrillators\",\n  \"Short title\": \"Clinical risk stratification for primary\",\n  \"Summary\": \"The authors developed dual risk stratification models to determine the competing risks of appropriate defibrillator shock versus mortality using a Fine-Gray subdistribution hazard model.\",\n  \"Citation\": \"<p>Lee DS, Hardy J, Yee R, Healey JS, Birnie D, Simpson CS, Crystal E, Mangat I, Nanthakumar K, Wang X, Krahn AD, Dorian P, Austin PC, Tu JV; Investigators of the Ontario ICD Database. <em>Circ Heart Fail<\/em>. 2015; 8(5):927-37. Epub 2015 Jul 29. <\/p>\",\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; A conceptualized model may be useful for understanding risk stratification of primary prevention implantable cardioverter defibrillators (ICDs) considering the competing risks of appropriate ICD shock vs mortality.<\/p>n<p><span class=\"bold\">Methods and Results<\/span> &mdash; In a prospective, multicenter, population-based cohort with left ventricular ejection fraction (LVEF) &le;35% referred for primary prevention ICD, we developed dual risk stratification models to determine the competing risks of appropriate defibrillator shock versus mortality using a Fine-Gray subdistribution hazard model. Among 7020 patients referred, 3445 underwent defibrillator implant (79.7% men, median 66 years [25<sup>th<\/sup>, 75<sup>th<\/sup>: 58-73]). During 5918 person-years of follow-up, appropriate shock occurred in 204 patients (3.6 shocks\/100 person-years) and 292 died (4.9 deaths\/100 person-years). Competing risk predictors of appropriate shock included nonsustained ventricular tachycardia, atrial fibrillation, serum creatinine concentration, digoxin or amiodarone use, and QRS duration near 130-millisecond peak. One-year cumulative incidence of appropriate shock was 0.9% in the lowest-risk category, and 1.7%, 2.5%, 4.9%, and 9.3% in low, intermediate, high, and highest-risk groups, respectively. Hazard ratios for appropriate shock ranged from 4.04 to 7.79 in the highest three deciles (all p &le;.001 vs lowest-risk). Cumulative incidence of one-year death was 0.6%, 1.9%, 3.3%, 6.2%, and 17.7% in lowest, low, intermediate, high, and highest-risk groups, respectively. Mortality hazard ratios ranged from 11.48 to 36.22 in the highest three deciles (all p &lt;.001 vs lowest-risk).<\/p>n<p><strong>Conclusions<\/strong> &mdash; Simultaneous estimation of risks of appropriate shock and mortality can be performed using clinical variables, providing a potential framework for identification of patients who are unlikely to benefit from prophylactic ICD.<\/p>n<p><a href=\"https:\/\/www.ahajournals.org\/doi\/abs\/10.1161\/CIRCHEARTFAILURE.115.002414\" title=\"Opens external link\">View full text<\/a><\/p>\",\n  \"Keywords\": \"{92E2791D-5DAB-4244-8A85-434D524D9A12}|{EDACCF0C-A0D0-4496-9216-D3055A23BC38}|{D130ADD9-0370-4BF6-9BBB-7379AF0263F0}\",\n  \"Research Programs\": \"{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}|{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}|{5A12C65D-3CDA-413E-BC94-C1D778156CE6}|{FBE2D1B1-C0BA-423F-8D16-39466B6C1424}\",\n  \"ICES Scientists\": \"{CEEE13AD-C7DE-455F-ACF8-AAD7D27BB178}|{3837E208-A045-4A55-9113-CA067609FCF2}|{7D498E8B-5801-4F9E-AC41-11ED50F3C34E}|{956599EC-5699-41D3-9375-E0B6C25B12D5}|{9EB22F72-67F1-409E-AB1B-D1C045367A84}\",\n  \"Posted Date\": \"20150729T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2015\/January\/Clinical-risk-stratification-for-primary-prevention-implantable-cardioverter-defibrillators"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Clinical risk stratification for primary prevention implantable cardioverter defibrillators<\/title>\n<meta name=\"description\" content=\"Background &#x2014; 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