Abstract 890: Risk Factors Associated With Poor Outcomes in the First 3 Months After an Implantable Cardioverter Defibrillator (ICD)
Determining risk factors for poor outcomes in the first year after sudden cardiac arrest and receipt of an implantable cardioverter defibrillator (ICD) will help providers reduce ICD complications and health care costs, and improve quality of life. The purpose of this study was to identify factors associated with poor physical and psychological outcomes in the first 3 months following an ICD.
Methods: A prospective design was used to follow 168 first time ICD recipients from hospital discharge after implant through 1 year. Poor outcomes at 3 months were defined as elevated anxiety (State-Trait Anxiety Inventory ≥40), depression (CES-D Scale ≥16), symptom burden (Patient Concerns Assessment-ICD ≥8), any ICD shocks (ICD interrogations) or any ICD related hospitalizations (discharge summary). Demographic, clinical, and outcomes data were collected at baseline ICD insertion and 3 months later. Logistic regression controlling for age, gender, co-morbidities, income, EF, ethnicity, ICD implant indication, and partner status was used to determine predictors of poor outcomes at 3 months.
Results: All participants received an ICD for secondary prevention of cardiac arrest, were 64.1±12.4 years old, 89% Caucasian, 77% male, with a mean ejection fraction (EF)%= 33.7±14.1. Elevated baseline anxiety (OR 1.36, 95% CI 1.07–1.42, p=0.004), baseline depression (OR 1.17, 95% CI 1.05–1.27, p=0.002), or baseline symptoms (OR 2.75, 95% CI 1.29 –3.01, p=0.005) were the best predictors of that same outcome at 3 months. The best predictor of ICD shocks at 3 months was EF% (OR 0.85, 95% CI 0.52–1.11, p=0.08). Receiving an ICD shock was the best predictor of re-hospitalization at 3 months (OR 3.25, 95% CI 1.56 – 6.74, p=0.002). Additionally, EF% was also a significant predictor of high symptom burden (p=0.02) and elevated depression (p=0.01) at 3 months.
Conclusions: Individuals should be screened for risk factors associated with poor outcomes at initial ICD implant. Use of more frequent follow-up and other interventions should be developed for ICD recipients at risk for poor outcomes (higher anxiety, depression, and symptom burden). These interventions will reduce re-hospitalization, ICD shocks, and improve health related quality of life after receiving an ICD.