Prevalence and prognostic impact of comorbidities in heart failure patients with implantable cardioverter defibrillator

Europace. 2007 Aug;9(8):681-6. doi: 10.1093/europace/eum097. Epub 2007 May 16.

Abstract

Aims: This study assessed the prevalence and the prognostic impact of comorbidities in heart failure patients with implantatable cardioverter-defibrillator (ICD).

Methods and results: We prospectively enrolled 146 patients with chronic heart failure, an ICD, and systolic dysfunction (mean ejection fraction 29 +/- 10%). Cardiac death was chosen as the primary endpoint. Death or appropriate ICD therapy, i.e. antitachycardia pacing/shock due to sustained ventricular tachycardia or ventricular fibrillation, was chosen as the secondary endpoint. Seventy-five patients (52%) had chronic kidney disease (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2)), 39 patients (27%) were anaemic, and 34 patients (23%) had diabetes mellitus. During a follow-up of 663 +/- 400 days, 22 patients (15%) died, and 41 patients (28%) received an appropriate ICD therapy. By multivariate Cox analysis, independent predictors of cardiac death were chronic kidney disease, age, and NYHA functional class. Death/appropriate ICD therapy were independently predicted by chronic kidney disease and QRS duration. In the presence of chronic kidney disease, outcome was significantly worse when compared with the absence (event-free survival rate 51 vs. 76%, P < 0.001).

Conclusion: In heart failure patients with an ICD, comorbidities are frequent but only the presence of chronic kidney disease is independently associated with increased morbidity and mortality.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Aged
  • Cardiac Output, Low / mortality*
  • Cardiac Output, Low / prevention & control*
  • Comorbidity
  • Death, Sudden, Cardiac / epidemiology*
  • Defibrillators, Implantable / statistics & numerical data*
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Analysis
  • Survival Rate
  • Ventricular Fibrillation / mortality*
  • Ventricular Fibrillation / prevention & control*