A clinical risk score to predict the time to first appropriate device therapy in recipients of implantable cardioverter defibrillators

Abstract

Background: To develop a risk score to predict the occurrence of appropriate defibrillator [implantable cardioverter-defibrillator (ICD)] therapies. A simple clinical score predicting the risk of appropriate ICD therapy is lacking. Methods: A Cox regression model was developed from a database of ICD patients at a single tertiary center to predict the time to appropriate ICD therapy defined as shock or antitachycardia pacing. A risk score was derived from this model using half of the database and was validated using the other half. Results: A total of 399 patients were entered into the database between July 2001 and February 2004. There were no statistically significant differences between the derivation (n = 200) and validation (n = 199) groups in any of the demographic or clinical variables recorded. The risk score included three independent variables: indication for ICD implantation (P = 0.03), serum creatinine level (P = 0.015), and QRS width (P = 0.028). The observed risk scores were highly predictive of time to ICD therapy in the validation group (P = 0.02). Conclusion: We describe a new clinical risk score that predicts the time to appropriate device therapy in ICD recipients of a single tertiary center hospital. The performance of this risk score needs to be investigated prospectively in a larger patient population. © 2007, The Authors.