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One‐year mortality after implantable cardioverter‐defibrillator placement within the Veterans Affairs Health System
Author(s) -
Fudim Marat,
Carlisle Matthew A.,
Devaraj Srikant,
Ajam Tarek,
Ambrosy Andrew P.,
Pokorney Sean D.,
AlKhatib Sana M.,
Kamalesh Masoor
Publication year - 2020
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1755
Subject(s) - medicine , implantable cardioverter defibrillator , veterans affairs , heart failure , quartile , sudden cardiac death , ejection fraction , population , life expectancy , cardiac resynchronization therapy , emergency medicine , cardiology , confidence interval , environmental health
Aims Implantable cardioverter‐defibrillator (ICD) therapy reduces mortality in patients with heart failure and current guidelines advise implantation of ICDs in patients with a life expectancy of >1 year. We examined trends in all‐cause mortality in patients who underwent primary or secondary prevention ICD placement in the Veterans Affairs (VA) Health System. Methods and results US veterans receiving a new ICD placement for primary or secondary prevention of sudden cardiac death between January 2007 and January 2015, who had heart failure with reduced ejection fraction (HFrEF) were included in the analysis. We assessed all‐cause mortality 1 year post‐ICD implantation. ICD implantation and HFrEF diagnosis were established with associated ICD‐9 codes. The VA death registry was utilized to identify mortality rates following ICD placement. Results were subsequently age‐stratified. There were 17 901 veterans with HFrEF with ICD placement nationwide. There was no statistically significant difference in 1‐year mortality from 2007 (13.1%) to 2014 (13.4%, P > 0.05). There was a significant increase in 1‐year mortality in patients in the oldest age quartile (81.6 years, 32.3% mortality) compared to the youngest quartile (55.5 years, 7% mortality). The finding of diverging clinical outcomes extended to the 30‐day but also 8‐year mark. Conclusions Our data suggest there is a high 1‐year mortality in aging HFrEF patients undergoing primary and secondary prevention ICD placement. This highlights the importance of developing better predictive models for mortality in our ICD eligible patient population.