Analysis of Mortality Risk Following Receipt of Implantable
Cardioverter/Defibrillators in Patients with and without Heart Failure
Abstract
ABSTRACT Rationale , aims, and objectives: Patients covered by the
Taiwan National Health Insurance (NHI) program are eligible to receive
an implantable cardioverter/defibrillator (ICD) if they had heart
failure (HF) or were determined to be at high risk of sudden cardiac
death (SCD). The aim of the study was designed to evaluate ICD recipient
prognoses with respect to contributory risks. Methods: From the NHI
research database, 2194 patients in Taiwan who received an ICD during
the 11 year period 2004-2014 was identified and then assigned to either
the no heart failure group (NHF, N=978) or the heart failure group (HF,
N=1160). Sub-groups of the NHF subjects analyzed further based on the
absence (NHFA, n=383) or presence (NHFP, n=595) of observed cardiac
arrhythmias. The mortality rates were reported and survival trends were
compared between groups. Results: The mean age of these patients was
61.8+/-15.2 years (men 69.2%). The HF group was older, (65 vs 58) and
had significantly more comorbidities. Pharmaceutical and medical
resource utilization was also uniformly higher within the HF group. The
30 day (1.8%) and one year (16.6%) mortality rates among the HF
patients were 3-4 times higher than in the NHF group. A coexistent major
diseases score was constructed and these analyses indicated the disease
score was consistently associated with a progressive mortality risk in
ICD recipients overall. Conclusions: Of those receiving ICDs, the
prognosis for HF patients is poorer than for those in the NHF group
which most likely reflects the fact that the HF patients were generally
older with more complicated medical conditions.