Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation: A report from the NCDR (National Cardiovascular Data Registry)

John A. Dodson, Matthew R. Reynolds, Haikun Bao, Sana M. Al-Khatib, Eric D. Peterson, Mark S. Kremers, Michael J. Mirro, Jeptha P. Curtis

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Objectives: To better inform patients and physicians of the expected risk of adverse events and to assist hospitals' efforts to improve the outcomes of patients undergoing implantable cardioverter-defibrillator (ICD) implantation, we developed and validated a risk model using data from the NCDR (National Cardiovascular Data Registry) ICD Registry. Background: ICD prolong life in selected patients, but ICD implantation carries the risk of periprocedural complications. Methods: We analyzed data from 240,632 ICD implantation procedures between April 1, 2010, and December 31, 2011 in the registry. The study group was divided into a derivation (70%) and a validation (30%) cohort. Multivariable logistic regression was used to identify factors associated with in-hospital adverse events (complications or mortality). A parsimonious risk score was developed on the basis of beta estimates derived from the logistic model. Hierarchical models were then used to calculate risk-standardized complication rates to account for differences in case mix and procedural volume. Results: Overall, 4,388 patients (1.8%) experienced at least 1 in-hospital complication or death. Thirteen factors were independently associated with an increased risk of adverse outcomes. Model performance was similar in the derivation and validation cohorts (C-statistics = 0.724 and 0.719, respectively). The risk score characterized patients into low- and-high risk subgroups for adverse events (≤10 points, 0.3%; ≥30 points, 4.2%). The risk-standardized complication rates varied significantly across hospitals (median: 1.77, interquartile range 1.54, 2.14, 5th/95th percentiles: 1.16/3.15). Conclusions: We developed a simple model that predicts risk for in-hospital adverse events among patients undergoing ICD placement. This can be used for shared decision making and to benchmark hospital performance.

Original languageEnglish (US)
Pages (from-to)788-796
Number of pages9
JournalJournal of the American College of Cardiology
Volume63
Issue number8
DOIs
StatePublished - Mar 4 2014
Externally publishedYes

Keywords

  • complication
  • implantable cardioverter-defibrillator
  • quality of care
  • registry

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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