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Article
Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation.pdf
J Am Coll Cardiol (2014)
  • Michael Mirro, Parkview Health
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 defibrillation (ICD) implantation, we developed and validated a risk model using data
from the National Cardiovascular Data Registry’s (NCDR®) ICD Registry™.

Background: ICDs prolong life in selected patients, but ICD implantation carries risk of
periprocedural complications.

Methods: We analyzed data from 240,632 ICD implantation procedures between 4/2010 and
12/2011 in the Registry. The population was divided into a derivation (70%) and a validation
(30%) cohort. Multivariable logistic regression was used to identify factors associated with inhospital
adverse events (complications or mortality). A parsimonious risk score was developed
based on 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 4388 (1.8%) of patients experienced at least one 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, IQR 1.54 to 2.14, 5th/95th percentiles
1.16/3.15).
Keywords
  • Implantable cardioverter defibrillator,
  • Quality of care,
  • Patient registry,
  • Patient outcomes
Disciplines
Publication Date
2014
DOI
10.1016/j.jacc.2013.09.079
Citation Information
Dodson, J. A., Reynolds, M. R., Bao, H., Al-Khatib, S. M., Peterson, E. D., Kremers, M. S., ... & Curtis, J. P. (2014). Developing a risk model for in-hospital adverse events following implantable cardioverter-defibrillator implantation: a report from the NCDR (National Cardiovascular Data Registry). Journal of the American College of Cardiology, 63(8), 788-796.