SPC365

Predictors for Adverse Outcomes in ICD/CRT-D Patients: Insights from a Single-Center Study

Session: SESSÃO DE POSTERS 48 - RESSINCRONIZAÇÃO CARDÍACA E CDI
Speaker: Sofia Andraz

Congress: CPC 2025
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Cartazes
FP Number: ---
Authors: Sofia Andraz; Joana Massa Pereira; Lucas Hamann; Miguel Espírito Santo; Joana Guerreiro Pereira; Hugo Costa; Pedro de Azevedo; Jorge Mimoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) are used for preventing sudden cardiac death and managing heart failure (HF). However, many patients still face adverse outcomes, highlighting the need to identify predictors to optimize patient selection and care.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objective</strong>: To compare ICD/CRT-D patients who developed adverse outcomes with those who did not and to identify predictors of these outcomes.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: This single-center retrospective study included consecutive patients who underwent ICD or CRT-D implantation between January 2020 and December 2023, with a mean follow-up of 35 months. Patients were grouped based on the occurrence of an adverse outcome &ndash; death, acute myocardial infarction, stroke and hospitalization for HF. Data were collected on demographic characteristics, HF medical therapy, device mode, administered device therapies and shocks, etiology and type of prevention. A multivariate logistic regression analysis was performed to identify independent predictors of adverse outcomes. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: The cohort included 264 patients and the adverse outcome occurred in 84 patients (32.4%). This group included older patients (66 vs. 65 years, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">=0.001) and had higher rates of diabetes mellitus (59.5% vs. 38.6%, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">=0.002), dyslipidemia (78.6% vs. 65.5%, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">=0.033), arterial hypertension (77.4% vs. 57.3%, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">=0.002), chronic kidney disease (28.4% vs. 17.0%, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">=0.036), and atrial fibrillation (AF, 35.7% vs. 21.5%, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">=0.015). CRT-D implantation was significantly more common in the group with an adverse outcome (32.5% vs. 15.4%, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">=0.002). Device therapies and/or shocks were more frequent in the adverse outcome group (29.0% vs. 16.0%, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">=0.026). Most patients implanted a device in primary prevention (70.2%), with no significant differences between groups. Mean follow-up duration was longer for patients with adverse outcomes (37 vs. 27 months, </span><span style="font-family:Cambria Math,serif">p</span><span style="font-family:Calibri,sans-serif">&lt;0.001). Multivariate analysis revealed that increasing age, AF diagnosis and lower left ventricular ejection fraction (FEVE) were independent predictors of adverse outcomes.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: Adverse outcomes occurred in 32.4% of patients, which presented older age, higher rates of comorbidities and mostly had a CRT-D. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Etiology was not significantly associated with differences in outcomes. Advanced age, AF and lower LVEF are independent predictors of adverse outcomes. These findings emphasize the importance of considering these factors during pre-implantation evaluations and post-procedural follow-up to optimize patient outcomes.</span></span></p>