Background Risk-benefit for cardiac resynchronisation therapy (CRT) defibrillator (CRT-D) over CRT pacemaker remains a matter of debate. We aimed to identify patients with a poor outcome within 1 year of CRT-D implantation, and to develop a CRT-D Futility score.
Methods Based on an administrative hospital-discharge database, all consecutive patients treated with prophylactic CRT-D implantation in France (2010–2019) were included. A prediction model was derived and validated for 1-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation.
Results Among 23 029 patients (mean age 68±10 years; 4873 (21.2%) women), 7016 deaths were recorded (yearly incidence rate 7.2%), of which 1604 (22.8%) occurred within 1 year of CRT-D implantation. In the derivation cohort (n=11 514), the final logistic regression model included—as main predictors of futility—older age, diabetes, mitral regurgitation, aortic stenosis, history of hospitalisation with heart failure, history of pulmonary oedema, atrial fibrillation, renal disease, liver disease, undernutrition and anaemia. Area under the curve for the CRT-D Futility score was 0.716 (95% CI: 0.698 to 0.734) in the derivation cohort and 0.692 (0.673 to 0.710) in the validation cohort. The Hosmer-Lemeshow test had a p-value of 0.57 suggesting accurate calibration. The CRT-D Futility score outperformed the Goldenberg and EAARN scores for identifying futility. Based on the CRT-D Futility score, 15.9% of these patients were categorised at high risk (predicted futility of 16.6%).
Conclusions The CRT-D Futility score, established from a large nationwide cohort of patients treated with CRT-D, may be a relevant tool for optimising healthcare decision-making.
- Defibrillators, Implantable
Data availability statement
Data are available on reasonable request.
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Contributors BM: Conceptualisation; investigation; methodology; writing—original draft; writing—review and editing. ABi, ABo: Formal analysis; writing—review and editing. JH: Data curation. BP, FF: Writing—review and editing. VK: Data curation. J-CD: Conceptualisation; investigation; methodology; writing—review and editing. LF: Conceptualisation; investigation; methodology; writing—original draft; writing—review and editing, overall content as guarantor.
Funding Sophie Rushton-Smith, PhD (MedLink Healthcare Communications, London), provided editorial assistance in the preparation of the manuscript (limited to editing for style, referencing, and figure and table editing) and was funded by the authors.
Competing interests LF reports being a consultant or speaker for Bayer, BMS/Pfizer, Boehringer Ingelheim, Medtronic and Novartis.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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