Dodson et al reported a model for in-hospital adverse event following implantation of a cardioverter-defibrillator (ICD). This can help to identify a patient who may benefit from more aggressive management. It can also benchmark a hospital's performance. The authors are from multiple institutions in the United States.
Patient selection: ICD implantation
Outcome: in-hospital adverse event (complications or mortality). Complications included cardiac arrest; cardiac perforation; coronary venous dissection; hemothorax; device-related infection; lead dislodgement; myocardial infarction; pericardial tamponade; pneumothorax; stroke/transient ischemic attack; urgent cardiac procedure; hematoma; or set screw problem.
Parameters:
(1) sex
(2) reason for admission
(3) NYHA functional class
(4) history of previous CABG
(5) current dialysis
(6) chronic lung disease
(7) abnormal cardiac conduction
(8) procedure type
(9) ICD type
(10) serum sodium in mmol/L
(11) hemoglobin in g/dL
(12) serum BUN in mg/dL
|
Parameter |
Finding |
Points |
|
sex |
male |
0 |
|
|
female |
2 |
|
reason for admission |
for ICD implant |
0 |
|
|
heart failure |
4 |
|
|
other |
5 |
|
NYHA functional class |
I or II |
0 |
|
|
III |
3 |
|
|
IV |
7 |
|
history of prior CABG |
no |
0 |
|
|
yes |
2 |
|
current dialysis |
no |
0 |
|
|
yes |
3 |
|
chronic lung disease |
no |
0 |
|
|
yes |
2 |
|
abnormal conduction |
no |
0 |
|
|
LBBB |
2 |
|
|
other |
2 |
|
procedure type |
initial implant |
13 |
|
|
generator replacement end of battery life |
0 |
|
|
generator replacement for infection |
17 |
|
|
generator replacement for device relocation |
18 |
|
|
generator replacement for upgrade |
12 |
|
|
generator replacement for malfunction |
13 |
|
|
other reason for generator replacement |
14 |
|
ICD type |
single chamber |
0 |
|
|
dual chamber |
4 |
|
|
cardiac resynchronization therapy with defibrillation |
6 |
|
sodium |
< 135 |
3 |
|
|
135 to 145 |
0 |
|
|
> 145 |
2 |
|
hemoglobin |
< 12 |
3 |
|
|
12 to 14 |
2 |
|
|
> 14 |
0 |
|
BUN |
< 20 |
0 |
|
|
20 to 40 |
2 |
|
|
> 40 |
4 |
total score =
=- SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 57
• The higher the score the greater the risk of an adverse event.
|
Score |
Risk of Adverse Event |
|
<= 10 |
0.3% |
|
11 to 29 |
|
|
>= 30 |
4.2% |
The data in Figure 2:
|
Score |
Risk of Adverse Event |
|
< 10 |
0.3% |
|
10 or 11 |
0.4% |
|
12 or 13 |
0.5% |
|
14 to 17 |
0.6% |
|
18 or 19 |
0.9% |
|
20 or 21 |
1.3% |
|
22 or 23 |
1.6% |
|
24 to 27 |
1.9% |
|
28 or 29 |
2.6% |
|
30 or 31 |
3.2% |
|
32 or 33 |
3.4% |
|
34 or 35 |
4.3% |
|
>= 36 |
5.7% |
Performance:
• The area under the ROC curve is 0.72.
Specialty: Cardiology
