Patients undergoing initial ICD placement for primary prevention who are currently hospitalized or have been recently hospitalized for heart failure (HF) may be more likely to experience periprocedural complications or death, according to a study published Sept. 13 in Circulation.

Andrew P. Ambrosy, MD, et al., used data from ACC's ICD Registry and Medicare claims to assess associations between the timing of ICD placement and outcomes during hospitalization and at 30 days and 90 days post implantation. The study cohort consisted of 81,180 patients with a diagnosis of HF with reduced ejection fraction (HFrEF) ≤35 percent who received an ICD for primary prevention.

Results showed that about 20 percent of the study population were currently hospitalized or had been hospitalized within three months. In addition, patients hospitalized at the time of ICD placement or within three months had higher rates of all-cause mortality, all-cause admissions and cardiovascular admissions at both 30 days and 90 days after implantation. At 30 days and 90 days after ICD placement, the complication rate was 5.24 percent and 7.75 percent for currently hospitalized patients and 3.3 percent and 6.25 percent for those hospitalized within three months, vs. 1.42 percent and 4.61 percent for patients who had a HF-related hospitalization more than three months before or had never been hospitalized for HF, respectively.

The investigators write that the drivers of the higher aggregate periprocedural, 30-day and 90-day complication rates in the patients currently or recently hospitalized were a higher rate of stroke/TIA, MI, cardiac arrest and death. "Additional research is required to clarify the signal of increased pocket infection, endocarditis, and other systemic infections as well as to identify approaches to mitigating the overall risk of infection in patients hospitalized for HF," they conclude.

Keywords: National Cardiovascular Data Registries, ICD Registry, Defibrillators, Implantable, Registries, Heart Failure, Primary Prevention

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