MADIT-ICD Predicted Benefit Score for ICDs

May 19, 2021
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Authors:
Younis A, Goldberger JJ, Kutyifa V, et al.
Citation:
Predicted Benefit of an Implantable Cardioverter-Defibrillator: The MADIT-ICD Benefit Score. Eur Heart J 2021;42:1676-1684.
Summary By:
Thomas C. Crawford, MD, FACC

Quick Takes

  • The authors identified eight predictors of VT/VF: male gender, age <75 years, prior nonsustained VT, heart rate >75 bpm, systolic blood pressure <140 mm Hg, EF ≤25%, history of myocardial infarction, and atrial arrhythmia.
  • The authors identified seven predictors of nonarrhythmic mortality: age ≥75 years, diabetes mellitus, body mass index <23 kg/m2, EF ≤25%, New York Heart Association class ≥II, ICD vs. cardiac resynchronization therapy with defibrillator, and atrial arrhythmia.
  • A personalized ICD benefit score based on the distribution of the two competing risk scores in the study population may be found at https://is.gd/madit.

Study Questions:

What tool can help physicians and their patients decide on the relative value of an implantable cardioverter-defibrillator (ICD) in a primary prevention population with reduced left ventricular ejection fraction (LVEF)?

Methods:

The study population comprised 4,531 patients enrolled in the MADIT trials. The authors developed prognostic models for ventricular tachycardia (VT) (≥200 bpm)/ventricular fibrillation (VF) versus nonarrhythmic mortality. Eight predictors of VT/VF (male, age <75 years, prior nonsustained VT, heart rate >75 bpm, systolic blood pressure <140 mm Hg, ejection fraction ≤25%, myocardial infarction, and atrial arrhythmia) and seven predictors of nonarrhythmic mortality (age ≥75 years, diabetes mellitus, body mass index <23 kg/m2, EF ≤25%, New York Heart Association class ≥II, ICD vs. cardiac resynchronization therapy with defibrillator, and atrial arrhythmia) were identified. The two scores were combined to create three MADIT-ICD benefit groups.

Results:

In the highest benefit group, the 3-year predicted risk of VT/VF was three-fold higher than the risk of nonarrhythmic mortality (20% vs. 7%, p < 0.001). In the intermediate benefit group, the difference in the corresponding predicted risks was attenuated (15% vs. 9%, p < 0.01). In the lowest benefit group, the 3-year predicted risk of VT/VF was similar to the risk of nonarrhythmic mortality (11% vs. 12%, p = 0.41).

Conclusions:

The authors proposed a novel MADIT-ICD benefit score predicting the likelihood of prophylactic ICD benefit through personalized assessment of the risk of VT/VF weighed against the risk of nonarrhythmic mortality.

Perspective:

The authors in this study attempt to provide a tool to help physicians and their patients make decisions about the relative value of ICD in primary prevention of sudden cardiac death in a population at risk for nonarrhythmic death. They developed a personalized ICD benefit score based on the distribution of the two competing risk scores in the study population (https://is.gd/madit), which may be used in patient-centered decision making about ICD therapy.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Blood Pressure, Body Mass Index, Cardiac Resynchronization Therapy, Death, Sudden, Cardiac, Defibrillators, Implantable, Diabetes Mellitus, Geriatrics, Myocardial Infarction, Primary Prevention, Risk Factors, Stroke Volume, Tachycardia, Ventricular, Ventricular Fibrillation, Ventricular Function, Left


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