Patients undergoing an implantable cardioverter-defibrillator (ICD) placement for a recent or current heart failure hospitalization had a higher rate of complications and were at increased risk of death compared to patients receiving an ICD without a recent hospitalization for heart failure, according to a study published in Circulation.
The authors of this study sought to evaluate whether the timing of a recent hospitalization for heart failure prior to ICD placement was associated with the subsequent outcomes, including in-hospital adverse events, post-discharge outcomes and readmissions, and mortality.
The authors performed an ad-hoc analysis on a cohort of 81,180 patients from the National Cardiovascular Data Registry’s ICD Registry with a diagnosis of heart failure undergoing a new ICD placement for primary prevention. Complications occurring during the periprocedural, 30-day, and 90-day periods were ascertained based on data reported in the ICD Registry.
Participants were grouped according to timing of ICD placement from last hospitalization for heart failure: patients currently hospitalized (n=11,563, 14%), recently hospitalized within 3 months (n=6252, 8%), or hospitalized more than 3 months before ICD placement or having no previous hospitalizations (n=63,365, 78%). Multivariable logistic regression models were used to determine the association between the timing of ICD placement and in-hospital, 30-day, and 90-day outcomes.
The unadjusted composite periprocedural complication rate for patients currently hospitalized for heart failure was 2.6% (2.32-2.91; P <.001), for patients hospitalized within 3 months was 1.71% (1.4-2.06; P <.001), and for patients hospitalized more than 3 months prior or with no previous hospitalizations was 1.25% (1.16-1.33; P <.001).
After adjusting for potential confounders, patients currently hospitalized for heart failure were at increased risk of in-hospital adverse events (odds ratio [OR], 1.61; 95% CI, 1.38-1.87; P <.001) and in-hospital mortality (OR, 5.56; 95% CI, 3.68-8.39; P <.001) compared to patients without hospitalization for heart failure in the last 3 months.
Patients recently hospitalized for heart failure similarly had higher odds of in-hospital mortality (OR, 2.79; 95% CI, 1.59-4.90; P <.001) relative to patients with no hospitalizations in the past 3 months.
Limitations of the study include the post-hoc nature of the analysis and the fact that timing of ICD placement was not randomized, which could reflect residual confounding. There was also no comparable cohort of clinically eligible patients who did not receive ICD placement. Thirty-day and 90-day complications were identified through Medicare claims data that may be inaccurate or lack detail. Finally, this study included only Medicare patients over 65 years, possibly limiting the ability to generalize the findings to younger patients with heart failure.
Patients currently or recently hospitalized for heart failure undergoing initial ICD placement experienced a higher rate of composite periprocedural, 30-day, and 90-day complications and were at increased risk of readmission and all-cause mortality compared with those without a recent heart failure hospitalization. Future studies are needed to define the optimal timing for real-world, effective ICD placement.
Ambrosy AP, Parzynski CS, Friedman DJ, et al. Is time from last hospitalization for heart failure to placement of a primary prevention implantable cardioverter-defibrillator associated with patient outcomes [published online September 13, 2018]. Circulation. doi:10.1161/circulationaha.118.035627