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Predictors of all-cause mortality in patients with implantable cardiac devices
Session:
Painel 1 -Insuficiencia cardiaca 3
Speaker:
Mafalda Carrington
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Mafalda Carrington; Afonso Nunes Ferreira; Pedro Silvério António; Inês Aguiar Ricardo; Tiago Graça Rodrigues; Joana Rigueira; Nelson P. Cunha; Rafael Santos; Pedro Morais; Igor Santos; Ana Bernardes; Fausto José Pinto; João Rodrigues De Sousa; Pedro Nuno Carlos Marques
Abstract
<p><u>Introduction</u>:</p> <p>Implantable Cardioverter Defibrillators (ICD), cardiac resynchronization therapy pacemakers (CRT-P) and the combination therapy (CRT-D) is recommended in patients (pts) with heart failure (HF) with reduced ejection fraction (EF), based on evidence that has shown a reduction in overall mortality compared with optimized medical therapy alone.</p> <p> </p> <p><u>Aim</u>:<br /> To compare the overall mortality effects of ICDs, CRT-Ds and CRT-Ps and how they vary according to baseline clinical characteristics.</p> <p> </p> <p><u>Methods</u>:</p> <p>Prospective single-center study of pts who implanted ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry of citizens. We performed uni and multivariate analysis using logistic and Cox regression methods to compare baseline clinical characteristics between device groups and to identify independent predictors of mortality in both ICD and CRT categories. We also used Kaplan-Meier methods to compare (un)adjusted mortality between the 3 types of devices.</p> <p> </p> <p><u>Results</u>:</p> <p>From 2015-2019, 414 ICDs, 316 CRT-Ds and 241 CRT-P were implanted and 161 (17%) of these pts died during a median follow-up of 22[12-34] months. Pts who received an ICD were younger comparing to pts with a CRT-D or CRT-P (77±8, 68±9, 61±12 years-old(yo), respectively, p<0.001) and they were more men (81%, 78% and 67%, respectively, p=0.010). The majority of pts with an ICD had ischaemic cardiomyopathy (CMP) (59%) and only 41% were in NYHA class≥2 (versus 97% in CRT group,p<0.001), while most with a CRT-D (52%) or CRT-P (69%) had dilated CMP and a more EF≤40% (76%, 88% and 99%, respectively,p<0.001). There were no significant differences between groups regarding risk factors and the remaining comorbidities. In pts with an ICD, the independent predictors of all-cause mortality were age (HR1.033;95%CI 1.00-1.06,p=0.041) and serum creatinine≥1.2mg/dl (HR2.134;95%CI 1.09-4.19,p=0.028), while in pts who had a CRT, besides age (HR 1.048;95%CI1.02-1.08,p=0.002) and creatinine (HR 1.756;95%CI1.45-2.13,p<0.001), HF aetiology (HR 0.650;95%CI0.44-0.96,p=0.031) was also a prognostic predictor. The unadjusted survival comparison between groups of devices showed that CRT pts had higher mortality comparing to ICD pts (HR 1.497;95%CI1.07-2.10,p=0.019) and that CRT-P pts died more than CRT-D pts (HR 1.676;95%CI1.14-2.46,p=0.008). After adjusting for age, creatinine and HF aetiology, all 3 devices exhibited comparable overall mortality rates.</p> <p> </p> <p><u>Conclusion</u>:</p> <p>In our cohort of pts with an ICD or CRT implantation, overall mortality during a median follow-up period of 2 years was 17%. After adjusting for age, creatinine and HF aetiology, there were no differences in overall mortality between the 3 types of devices. Guidelines on device implantation should consider the value of age, creatinine and HF aetiology as predictors of all-cause mortality.</p>
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