Abstract 11672: Incidence of Implantation of Implantable Cardioverter Defibrillators Within 90 Days in Patients Surviving Non-Myocardial Infarction Out-of-hospital Cardiac Arrest in Denmark Between 2001-2012
Introduction: For patients surviving out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, implantable cardioverter defibrillator (ICD) is recommended unless the arrest was caused by a reversible condition (acute myocardial infarction (AMI)). Yet, other factors may also influence decision to implant ICD.
Aim: To determine factors associated with implantation of ICD in patients surviving non-AMI OHCA in a nationwide registry covering all OHCAs in Denmark.
Methods: We identified 36,950 OHCAs between 2001-2012, 1,933 of whom were without prior ICD, ≥ 18 years, not diagnosed with AMI and surviving until discharge. 1,732 had no ischemic heart disease (IHD) diagnosis, 201 had chronic IHD diagnosis ≤ two days post OHCA. Multiple logistic regression was used to identify factors associated with ICD implantation ≤ 90 days post OHCA.
Results: In patients with no IHD, the incidence of ICD implantation increased over time (OR: 1.07 per year, CI: 1.03-1.1, p=0.001, fig 1). Witnessed arrest, bystander defibrillation and cardiac etiology were associated with higher odds of ICD (ORwitnessed: 2.2, CI: 1.6-3.0, p<0.001, ORdefibrillation: 2.9, CI: 1.6-5.2, p<0.001, ORetiology: 16, CI: 5.7-45, p<0.001), and non-shockable rhythm was associated with lower odds of ICD (OR: 0.2, CI: 0.1-0.3 p<0.001). Age ≥ 80 years was associated with lower odds of ICD in patients without IHD (OR: 0.2, CI: 0.1-0.3, p<0.001) as well as patients with IHD (OR: 0.1, CI: 0.01-0.5, p<0.01). In patients with IHD, top income tertile, Charlson comorbidity index (CCI) 1 and witnessed arrest were associated with higher odds of ICD (ORtop income: 9.7, CI: 1.6-58.6, p=0.01, ORCCI1: 5.3, CI: 1.7-17, p<0.01, ORwitnessed: 3.4, CI: 1.1-10, p=0.04).
Conclusion: ICD implantation rates increased over the study period in non-IHD patients, but not in patients with IHD. ICD implantation was less likely in patients ≥ 80 years. High income and low comorbidity burden was associated with higher odds in patients with IHD.
Author Disclosures: M. Winther-Jensen: None. J. Kjaergaard: None. J. Flensted Lassen: None. L. Kober: None. C. Torp-Pedersen: None. S. Moller Hansen: None. F.K. Lippert: None. E. Frischknecht Christensen: None. C. Hassager: None.
- © 2016 by American Heart Association, Inc.