Abstract 12307: Atrial Fibrillation is a Strong Risk Factor for Adverse Cardiovascular Outcomes in Patients With Implantable Cardioverter-Defibrillators
Purpose: The use of implantable cardioverter-defibrillator (ICD) continues to increase. Our knowledge of predictors of adverse cardiovascular (CV) outcomes in patients with ICDs is mostly derived from clinical trials. This hospital-based retrospective cohort study aims to identify predictors of adverse CV outcomes in patients with ICD in a real-world setting.
Methods: We identified consecutive patients who had ICD implantation at the University of Minnesota Medical Center between Jan 1, 2008 and Dec 31, 2009. Baseline data on demographics, CV risk factors and diagnoses, and medications were collected from charts. The follow-up was through Dec 31, 2012. Our primary outcome is a composite CV outcome (table). We used multivariable Cox proportional hazards model and a stepwise selection method to fit the most parsimonious model to predict the composite outcome.
Results: We included 166 patients [mean age (SD), 60 (15) years; 74% male]; 64 (38.8%) patients had diabetes (DM) and 140 (84.3%) were on beta-blockers (BB) at baseline. The ICD was placed in 119 (71.7%) patients for primary prevention and 47 (28.3%) for secondary prevention of sudden cardiac death. There were 98 patients (59.0%) with the composite outcome and 25 (15.1%) with incident or recurrent atrial fibrillation (AF). The median follow-up was 633 days. The full model included age, sex, coronary artery disease, DM, hypertension, LV ejection fraction, use of BB, anticoagulants, estimated GFR, and incident or recurrent AF. The table shows the most parsimonious model for prediction of the composite outcome.
Conclusions: In patients with ICDs, the presence of AF is significantly associated with a 5-fold increased risk of adverse CV outcomes while the use of BB is associated with lower risk. Our study suggests that AF is a strong risk factor for adverse CV outcomes in patients with ICDs. Further research is warranted to determine whether maintaining sinus rhythm in patients with AF and ICD would lead to improved outcomes.
Author Disclosures: I.C. Chang: None. E. Austin: None. W.O. Adkisson: None. H. Roukoz: None. L.N. von Wald: None. S. Sakaguchi: None. D.G. Benditt: None. L.Y. Chen: None.
- © 2014 by American Heart Association, Inc.