Use and long-term outcomes of implantable cardioverter-defibrillators, 1990 to 2009

Am Heart J. 2013 May;165(5):816-22. doi: 10.1016/j.ahj.2013.02.007. Epub 2013 Mar 19.

Abstract

Background: Automated implantable cardioverter-defibrillators (ICDs) have become standard therapy for patients at high risk for sudden cardiac death. Linked data allow examination of trends in use and long-term survival after ICD implantation in an adult population.

Methods: Linked state-wide person-based data on hospital admissions and deaths from 1980 to 2009 were used to identify incident cases of ICD implantation. Population rates were calculated using census data. Kaplan-Meier techniques were used to describe cumulative survival. Cox regression models were used to determine the factors associated with the outcomes.

Results: Between 1988 and 2009, 1593 devices were implanted in patients in Western Australia, rising from 2 in 1988 to 245 in 2009; standardized population rates rose from 0.8 in 100000 in 1995 to 14.9 in 100000 in 2009. Mean age rose from 52.6 (SD 11.6) to 64.1 (11.4) years. Ventricular tachycardia (23%), cardiomyopathy (18%), and heart failure (16%) were the most frequent principal diagnoses. Ischemic heart disease was present in 49% of patients. Five-year cumulative survival was 0.74 (SE 0.01), and at 10 years, 0.53 (SE 0.03); median survival was 11.3 years. Readmission within a year, older age, heart failure, device complications, and chronic ischemic heart disease were associated with poorer survival.

Conclusions: Implantable cardioverter-defibrillator use in adults at risk for sudden cardiac death has grown rapidly. Readmission within 12 months of discharge is associated with worse medium and long-term mortality. Survival for most patients younger than 65 years exceeds 10 years and 5 years for those aged ≥75 years.

Publication types

  • Comparative Study

MeSH terms

  • Death, Sudden, Cardiac / epidemiology*
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Heart Failure
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Tachycardia, Ventricular / mortality
  • Tachycardia, Ventricular / therapy*
  • Time Factors
  • Treatment Outcome
  • Western Australia / epidemiology