Abstract 13665: Implantable Cardioverter Defibrillator Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk of Early and Long-Term Mortality
Introduction: Despite chronic obstructive pulmonary disease (COPD) being recognized as a risk factor for mortality in the general population, the impact of COPD diagnosis on early (<1 year) and long-term mortality (>=3 years) in patients at high risk of sudden cardiac death (SCD) with implantable cardioverter defibrillator (ICD) is inadequately studied.
Methods: Consecutive patients from Jan 2010 to Dec 2013 who underwent an ICD placement were included and differences in overall mortality within 1 year and 3 years after ICD implant between COPD and non-COPD patients were determined using Kaplan-Meier analysis. Predictors of early and late mortality were determined using logistic regression.
Results: Out of 3,464 patients (mean age 66.5 ± 13.3), 926 (26.7%) patients had a diagnosis of COPD. Overall mortality within 1 year after ICD implantation was 1.62 fold higher in patients with COPD (13% vs 8%: p<0.001) and 1.54 fold higher at 3 years (34% vs 22%: p<0.001) [Figure]. There was no significant age or gender difference between those with and without COPD. Patients with COPD were more likely to have history of myocardial infarction, ischemic cardiomyopathy, heart failure, atrial fibrillation, hypertension, diabetes, hyperlipidemia, obstructive sleep apnea and left ventricle ejection fraction <35%. On logistic regression analysis after correction for these baseline differences, COPD remained an independent predictor of early and late mortality [HR 1.40 (95% CI: 1.22 - 1.61; p-value <0.0001)]. Other independent predictors of mortality were age >65 years, history of heart failure, dialysis, atrial fibrillation and diabetes mellitus.
Conclusions: COPD is associated with both early and long-term mortality in patients receiving ICD implant for high risk of SCD. Whether a more aggressive management of COPD improves survival in this high-risk population needs to be further assessed for the benefit of this lifesaving but expensive therapy to be maximized.
Author Disclosures: M. Shahreyar: None. M. Mirza: None. R. Shearer: None. I. Choudhuri: None. V. Nangia: None. M. Mortada: None. A. Dhala: None. I. Niazi: None. A. Bhatia: None. J. Sra: None. A. Jahangir: None.
- © 2015 by American Heart Association, Inc.