Can we identify patients who may not benefit from ICD therapy? 

An observational study showed that frailty and severe comorbidity were strong predictors of death without appropriate therapy in patients with implantable cardioverter defibrillators (ICDs), suggesting that certain patients may not benefit from ICD therapy.

“Although ICDs decrease mortality by reducing the risk for sudden cardiac death, most patients with these devices do not receive life-prolonging therapy,” explained Dr David Wilson (Worcestershire Royal Hospital, UK). “Older patients and patients with numerous comorbidities may have an increased risk of non-arrhythmic death and the benefits of ICDs may therefore be reduced in these patients.”

The current prospective, multicentre, observational COMFORT-Q study included 662 patients with ICDs to investigate which are the most important contributors to ‘death with no appropriate therapy,’ which was the main outcome of the study. The research team asked the participants to complete several health questionnaires including the Fried frailty score, the 12-Item Short-Form Health Survey (SF-12), the EQ-5D-5L, and the Charlson comorbidity index. The mean age of the study population was 65.6 years, 23% were women, 12% of the participants were considered frail, and 11% of the participants had a severe Charlson comorbidity index.

After a follow-up of 2.5 years, 63 participants had died of whom 54 had died without receiving appropriate ICD therapy. Frailty was the strongest independent predictor for death without appropriate therapy (OR 3.41; P<0.001). Severe comorbidity (OR 2.72; P<0.001) and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² (OR 2.16; P<0.001) were other significant predictors for this event to occur. Age >70 years and an EQ-5D-5L score <0.6 were not significantly associated with ‘death without appropriate therapy’.

1. 1. Wilson D, et al. Co-morbidities, frailty, functional status in ICD recipients: The COMFFORT-Q study. Devices – Round 2 – Others, EHRA 2023, 16–18 April, Barcelona, Spain.

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