Predictors of Unfavorable Prognosis in Patients with Heart Failure After Cardioverter-Defibrillator Implantation According to the Prospective Part of the Kuzbass Registry.

AIM: Identification of clinical and instrumental predictors for non-arrhythmic death in patients with heart failure (HF) and implantable cardioverter-defibrillator (ICD). MATERIAL AND METHODS: Through a telephone survey and examination of medical records from hospital and polyclinic databases, data were obtained on the alive/dead status and causes of death for 260 patients with heart failure (HF) and ICD included in the Kuzbass Registry of Patients with ICD. The follow-up period was 1.5 years. Clinical and instrumental parameters entered into the registry before the ICD implantation were included in a univariate and multivariate step-by-step analysis using the logistic (for qualitative variables) and linear (for quantitative variables) regression with calculation of regression coefficients and construction of a prognostic regression model. The quality of the created model was assessed using a ROC analysis. RESULTS: During the observation period, 54 (20.8%) patients died. In 21 (38.8%) patients, death occurred in the hospital and was caused by acute decompensated heart failure in 15 (71.4%) patients, myocardial infarction in 3 (14.3%) patients, stroke in 1 (4.7%) patient, and pneumonia in 2 (9.5%) patients. 33 (61.2%) patients died outside the hospital; the cause of death was stated as the underlying disease associated with acute decompensated heart failure: in 9 (27.2%) patients, dilated cardiomyopathy; in 1 (3.0%) patient, rheumatic mitral disease; and in 23 (69.7%) patients, ischemic cardiomyopathy. According to the univariate regression model, the risk of death in the long-term period was increased by the QT interval prolongation (U 2.41, p = 0.0161); elevated pulmonary artery systolic pressure (U 4.30, p=0.0000) and increased left atrial size according to echocardiography (U 2.98, p=0.0029); stage IIB HF (OR 2.41; 95% CI: 1.26-4.6), NYHA III-IV (OR 3.03; 95% CI: 1.58-5.81); chronic obstructive pulmonary disease (OR 5.24; 95% CI: 2.04-13.45); and lack of optimal drug therapy (ODT) for HF before ICD implantation (OR 2.41; 95% CI: 1.29-4.49). The multivariate analysis identified the most significant factors included in the prognostic regression model: pulmonary artery systolic pressure above 45 mm Hg, social status, chronic obstructive pulmonary disease, and lack of ODT for HF. CONCLUSION: To ensure a maximum benefit from ICD, the factors that increase the likelihood of non-arrhythmic death should be considered before making a decision on ICD implantation. Particular attention should be paid to mandatory ODT for HF as the main modifiable risk factor for unfavorable prognosis.

Long-term outcomes in patients with an implanted cardioverter-defibrillator according to the Kuzbass registry.

Aim    To analyze long-term outcomes by results of the prospective part of the Kuban registry of patients with an implantable cardioverter defibrillator (ICD).Material and methods    A prospective analysis of the incidence of hard endpoints and changes in the condition was performed for 260 patients with ICD successively added to the Registry of Patients with Implantable Cardioverter Defibrillator" from 2015 through 2019.Results    At the time of ICD implantation, all patients had chronic heart failure (CHF), mostly of ischemic etiology with a low left ventricular ejection fraction (LVEF); median LVEF was 30 (25; 36.5) %. 54 of 266 (21.9 %) patients died by 2021; 17 of them (31.5 %) died in the hospital; in 76.5 % of cases, death was caused by acute decompensated heart failure (HF). 139 (53.5%) patients were readmitted; 66 (25.4 %) hospitalizations were related with ICDs (lead revision or reimplantation); acute cardiovascular events developed in 38 (14.6 %) patients; 12 (4.6%) patients underwent percutaneous coronary interventions; orthotopic heart transplantation was performed for 4 patients. ICD shocks were recorded in 27 (10.4 %) patients. After the ICD implantation, median LVEF remained unchanged, 31 (25; 42) vs. 30 (25; 36.5) % (р>0.05). However, both objective and subjective HF symptoms worsened. Thus, the number of patients with IIB stage CHF increased from 29.6  to 88.8 % (р<0.01) and with NYHA III CHF from 24.2  to 34.5 % (p<0.05). 80 (30.8%) patients visited cardiologists on a regular basis. Only 7.3% of patients received an optimal drug therapy. During the observation period, the rate of beta-blocker treatment considerably decreased, from 90.6  to 64.3 % (р<0.01), and the rate of the mineralocorticoid receptor antagonist treatment decreased from 50.8  to 17.4 % (р<0.01). The rate of the diuretic treatment was inconsistent with the severity of patients' condition.Conclusion    Most of the problems the patients encountered after the ICD implantation were related with an inadequate treatment of the underlying disease. Since the majority of patients with ICD have a low LVEF, it is essential to focus on prescribing an optimal drug therapy and maintaining compliance with this therapy.

[Clinical and anamnestic characteristics of patients with an implanted cardioverter-defibrillator in real clinical practice (data from the Kuzbass register)].

Aim      To study the consistency of the practice of management, selection and routing of patients at high risk of sudden cardiac death (SCD) selected for cardioverter-defibrillator implantation (CDI) with current clinical guidelines and to evaluate the quality of subsequent outpatient follow-up and treatment based on a retrospective analysis of clinical amnestic data from the Kuzbass Registry of Patients with CDI.Material and methods  The study was based on the Registry of Patients with Implanted Cardioverter Defibrillator and included successive data of 28 patients hospitalized to the Kizbass Cardiological Center from 2015 through 2019. Social and clinical amnestic characteristics, indications for CVI, and concomitant drug therapy were analyzed retrospectively. Statistical analyses were performed with the Statistica 10.0 software (Statsoft, USA).Results Median age of patients was 59 (53; 66) years; 239 (83.6 %) men were included; 29 (10.1%) people were employed, CHI was performed in 182 (63.6 %) patients for prevention of SCC, and for secondary prevention in 104 (36.4 %) patients. 208 (72.7 %) patients were diagnosed with ischemic heart disease (IHD), and 145 (67.9 %) of them underwent myocardial revascularization. Noncoronarogenic diseases were found in 78 (27.3 %) patients, and most of them were diagnosed with dilated cardiomyopathy. All patients had chronic heart failure (CHF); half of them had stage IIA CHF. Median left ventricular ejection fraction was 30 (25; 36,5) % according to echocardiography using the Simpson method. Comorbidity was found in 151 (52.8 %) patients. 128 (44.8%) patients received a triple neurohormonal blockade for CHF treatment; titration to target doses was not performed in any of them. Antiarrhythmics were administered to 150 (52.4 %) patients.Conclusion      According to the data from the Kuzbass Registry of CVI, the main patient cohort consisted of men of pension age with IHD and CHF. Before CVI, more than a half of them had not received an optimum drug therapy and not all of them had received target lesion revascularization. Creating and analysis of Registries of CHI patients is an effective method for identifying existing problems in patient management before CVI and for optimizing their subsequent follow-up and treatment.