Journal Article

116 Mortality prediction using charlson comorbidity index in patients undergoing implantable cardiac defibrilator implantation

Carr, Fiona, Lewis, Nigel, Crapper, Ryan

2024

Overview

IntroductionThe Charlson comorbidity index (CCI) is a validated 10-year mortality risk score. It has been validated in patients with cardiovascular disease showing a high comorbidity score correlates with increased mortality.1 2 We applied and validated this risk score retrospectively to our implantable cardiac defibrillator (ICD) therapy cohort to determine its utility in aiding decision making for ICD therapy in comorbid patients.MethodsAll consecutive ICD implants (April 2018- March 2019) at our tertiary centre were reviewed retrospectively and CCI calculated using device implantation documentation, GP records and blood results at time of implant. Patients were followed up until November 2022 and all cause mortality data recorded during this period (median follow up 1428 days +/- 331 days). Comparison was made for calculated CCIs between surviving and deceased patients with sub group analysis of primary or secondary prevention indication, arrhythmic presentation and underlying pathological aetiology. Data was analysed using Microsoft Excel3 and Chi squared and Log rank analysis was performed on the data using an online Kaplan-Meier survival analysis tool.4 Results118 ICDs were implanted between April 2018-March 2019, 24 patients (20.3%) died in the follow up period. Median age at implant was 63.4 years +/- 12.8 years with predominant Male sex (80.5%). The majority had ischaemic aetiology (55.9%) with equal distribution between primary and secondary prevention indications (48.3% & 50.8%). Deceased patients had a higher median CCI compared to surviving patients 5.9 (+/- 1.9) vs 4 (+/- 2.2). A CCI >5 was associated with increased mortality (38.4%) compared to a CCI ≤5 (13.1%) (p<0.001). Similar findings were seen across the sub group analysis. A total of 66.6% of deceased patients received no ICD therapies prior to death, with 29.1% receiving multiple appropriate therapies.ConclusionIn our cohort, a CCI >5 was associated with significantly increased all cause mortality, independent of aetiology, arrhythmic presentation and device indication.ReferencesCharlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. doi: 10.1016/0021–9681(87)90171–8. PMID: 3558716.Radovanovic D, Seifert B, Urban P, Eberli FR, Rickli H, Bertel O, Puhan MA, Erne P; AMIS Plus Investigators. Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002–2012. Heart 2014 Feb;100(4):288–94. doi: 10.1136/heartjnl-2013–304588. Epub 2013 Nov 1. PMID: 24186563.Radovanovic D, Seifert B, Urban P, Eberli FR, Rickli H, Bertel O, Puhan MA, Erne P; AMIS Plus Investigators. Validity of Charlson Comorbidity Index in patients hospitalised with acute coronary syndrome. Insights from the nationwide AMIS Plus registry 2002–2012. Heart 2014 Feb;100(4):288–94. doi: 10.1136/heartjnl-2013–304588. Epub 2013 Nov 1. PMID: 24186563.Microsoft Excel, Microsoft Inc, Redmond, WA, USAKaplan Meier Survival Analysis (internet); Statistics Kingdom 2017 (cited November 2023). Available from https://www.statskingdom.com/kaplan-meier.htmlConflict of InterestNilAbstract 116 Figure 1

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Acute coronary syndromes / Arrhythmia / Cardiac rhythm management / Comorbidity / Defibrillator / Etiology / Mortality / Survival analysis / Transplants & implants