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Heart rate score predicts mortality independent of shocks in ICD and CRT-D patients

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Heart Rate Score (HrSc), a novel index found to predict mortality in patients with implantable defibrillator (ICD) and cardiac resynchronization defibrillator (CRT-D) devices, is associated with mortality in ICD and CRT-D recipients when HrSc is ≥ 70%. Implantable defibrillator shocks have also been associated with increased mortality in ICD and CRT-D recipients. The objective of this study was to evaluate the relationships between HrSc, shocks, and mortality in ICD and CRT-D patients.

Methods

HrSc was calculated from atrial sensed and paced rate histograms collected from the 2006–2011 ALTITUDE remote interrogation database. Shocks were determined in the first year of follow-up. Mortality was assessed over the next 4 years by the Social Security Death Index. Four multivariable models were run: ICD and CRT-D, shock and no shock, with mortality as the outcome and HrS as predictor.

Results

Data from 49,358 ICD and 55,953 CRT-D patients were divided into HrSc: ≥ 70%, 30–69%, and < 30%. Shock rates differed between HrSc groups (p < 0.001) for ICD and CRT-D patients. However, the lowest mortality risk HrSc (< 30%) had the highest shock rate. Both highest HrSc (> 70%; p < 0.001) and shocks (p < 0.001) predicted mortality during follow-up. Mortality was unrelated to interactions between HrSc and shocks in ICD patients (p = 0.275) or CRT-D patients (p < 0.079). Comparing HrSc ≥ 70% to HrSc < 30%, HrSc ≥ 70% predicted mortality in CRT-D (HR 1.40; 95% CI 1.29–1.52) and ICD (HR 1.23; 95% CI 1.11–1.36) patients regardless of shocks (P < 0.001 for both).

Conclusions

Patients with ICDs or CRT-Ds having the lowest mortality risk HrSc had the highest shock rate. Shocks and HrSc appear to complement each other as predictors of mortality.

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Funding

B. Olshansky, B. Wilkoff, and M. Richards received no compensation for this work.

P. Jones, N. Wold, D. Pershbacher, and A. Sharma received salary support from Boston Scientific but not specifically for this project.

Boston Scientific did not charge for the database.

Author information

Authors and Affiliations

  1. Mercy Hospital- North Iowa, Mason City, IA, USA

    Brian Olshansky

  2. University of Iowa, 200 Hawkins Drive, Room 4426A JCP, Iowa City, IA, 52242, USA

    Brian Olshansky

  3. Promedica Physicians Cardiology, Toledo, OH, USA

    Mark Richards

  4. Boston Scientific, St. Paul, MN, USA

    Arjun D. Sharma, Paul W. Jones, Nick Wold & David Perschbacher

  5. Cleveland Clinic, Cleveland, OH, USA

    Bruce L. Wilkoff

Authors
  1. Brian Olshansky
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  2. Mark Richards
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  3. Arjun D. Sharma
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  4. Paul W. Jones
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  5. Nick Wold
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  6. David Perschbacher
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  7. Bruce L. Wilkoff
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Corresponding author

Correspondence to Brian Olshansky.

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Conflict of interest

Brian Olshansky: Lundbeck, Boehringer Ingelheim, Amarin, Respicardia, Sanofi Aventis

Mark Richards: Boston Scientific, Boehringer Ingelheim, Medtronic, Biotronik, Janssen, Pfizer

Arjun Sharma: Cardialen, VivaQuant, 3M

Paul W. Jones: Boston Scientific

Nick Wold: Boston Scientific

David Pershbacher: Boston Scientific

Bruce L. Wilkoff: Consultant: Medtronic, St. Jude, Spectranetics, Speaker: Medtronic, Spectranetics, St. Jude, Convatec

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Olshansky, B., Richards, M., Sharma, A.D. et al. Heart rate score predicts mortality independent of shocks in ICD and CRT-D patients. J Interv Card Electrophysiol 58, 103–111 (2020). https://doi.org/10.1007/s10840-019-00688-8

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  • DOI: https://doi.org/10.1007/s10840-019-00688-8

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