The impact of co-morbidity burden on appropriate implantable cardioverter defibrillator therapy and all-cause mortality: insight from Danish nationwide clinical registers

Research output: Contribution to journalJournal articleResearchpeer-review

  • Anne Christine Ruwald
  • Michael Vinther
  • Gislason, Gunnar Hilmar
  • Jens Brock Johansen
  • Jens Cosedis Nielsen
  • Helen Høgh Petersen
  • Sam Riahi
  • Christian Jons

AIMS: In a nationwide cohort of primary (PP-ICD) and secondary prevention (SP-ICD) implantable cardioverter defibrillator (ICD) patients, we aimed to investigate the association between co-morbidity burden and risk of appropriate ICD therapy and mortality.

METHODS AND RESULTS: We identified all patients >18 years, implanted with first-time PP-ICD (n = 1873) or SP-ICD (n = 2461) in Denmark from 2007 to 2012. Co-morbidity was identified in administrative registers of hospitalization and drug prescription from pharmacies. Co-morbidity burden was defined as the number of pre-existing non-ICD indication-related co-morbidities including atrial fibrillation, diabetes, chronic obstructive pulmonary disease, chronic renal disease, liver disease, cancer, chronic psychiatric disease, and peripheral and/or cerebrovascular disease, and divided into four groups (co-morbidity burden 0, 1, 2, and ≥3). Through Cox models, we assessed the impact of co-morbidity burden on appropriate ICD therapy and mortality. Increasing co-morbidity burden was not associated with increased risk of appropriate therapy, irrespective of implant indication [all hazard ratios (HRs) 1.0-1.4, P = NS]. Using no co-morbidities as reference, increasing co-morbidity burden was associated with increased mortality risk in PP-ICD patients (co-morbidity burden 1, HR 2.1; comorbidity burden 2, HR 3.7; co-morbidity burden ≥3, HR 6.6) (all P < 0.001) and SP-ICD patients (co-morbidity burden 1, HR 2.2; co-morbidity burden 2, HR 3.8; co-morbidity burden ≥3, HR 5.8). With increasing co-morbidity burden, an increasing frequency of patients died without having utilized their device, with 72% PP-ICD and 45% SP-ICD patients with co-morbidity burden ≥3 dying without prior appropriate ICD therapy.

CONCLUSION: Increasing co-morbidity burden was not associated with increased risk of appropriate ICD therapy. With increasing co-morbidity burden, mortality increased, and a higher proportion of patients died, without ever having utilized their device.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Issue number3
Pages (from-to)377-386
Number of pages10
Publication statusPublished - Mar 2017

    Research areas

  • Aged, Atrial Fibrillation/epidemiology, Cerebrovascular Disorders/epidemiology, Cohort Studies, Comorbidity, Death, Sudden, Cardiac/epidemiology, Defibrillators, Implantable, Denmark/epidemiology, Diabetes Mellitus/epidemiology, Female, Humans, Liver Diseases/epidemiology, Male, Mental Disorders/epidemiology, Middle Aged, Neoplasms/epidemiology, Peripheral Vascular Diseases/epidemiology, Primary Prevention, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive/epidemiology, Registries, Renal Insufficiency, Chronic/epidemiology, Retrospective Studies, Secondary Prevention

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