Impact of an Age-Adjusted Co-morbidity Index on Survival of Patients With Heart Failure Implanted With Cardiac Resynchronization Therapy Devices

Abstract

Age is an adverse prognostic factor in patients with heart failure. We aimed to assess the impact of age and noncardiac co-morbidities in the outcome of patients undergoing cardiac resynchronization therapy (CRT), and determine which of these two factors is the most important predictor of survival. The study involved a single-center retrospective assessment of 697 consecutive CRT implants during a 12-year period. Patient co-morbidity profile was assessed using the Charlson Co-morbidity Index (CCI) and the Charlson Age-Co-morbidity Index (CACI). Predictors of survival free from heart transplantation were assessed. CRT-related complications and cause of death analysis were assessed within tertiles of the CACI. During a mean follow-up of 1,813 ± 1,177 days, 347 patients (49.9%) died and 37 (5.3%) underwent heart transplantation. On multivariate Cox regression, female gender (HR = 0.78, 95% confidence interval [CI] 0.62 to 0.99, p = 0.041), estimated glomerular filtration rate (HR per ml/min = 0.99, 95% CI 0.98 to 0.99, p < 0.001), left ventricular ejection fraction (HR per % = 0.99, 95% CI 0.98 to 1.00, p = 0.022), New York Heart Association class (HR = 1.83, 95% CI 1.53 to 2.20, p < 0.001), presence of left bundle branch block (HR = 0.70, 95% CI 0.56 to 0.87, p = 0.001), and CACI tertile (HR = 1.37, 95% CI 1.18 to 1.59, p < 0.001) were independent predictors of all-cause mortality or heart transplantation. Compared with age and the CCI, the CACI was the best discriminator of all-cause mortality. Inappropriate therapies occurred less frequently in higher co-morbidity tertiles. In conclusion, patient co-morbidity profile adjusted to age impacts on mortality after CRT implantation. Use of the CACI may help refine guideline criteria to identify patients more likely to benefit from CRT.

Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation

“…The CCI and ACCI became increasingly popular in medical research studies between 2005 and 2010 because they can be calculated using health claims data for clinical, epidemiological, or costutility studies [12,13,19,22]. The CCI was originally designed to predict mortality or the costs associated with chronic diseases in patients and has been extended to evaluate outcome after heart failure treatment [17] or ICU treatment [23]. However, whether it can be used as a prognostic index for acute care after ECPR has not been previously investigated.…”

“…Among them, the Charlson comorbidity index (CCI) [10] and age-adjusted CCI (ACCI) [11] have been repeatedly validated for estimating the longitudinal prognosis associated with multiple pre-existing comorbidities [12,13]. The ACCI has also been validated [14] in clinical scenarios such as cancer [15,16], heart failure [17], infectious disease, emergency surgery [18], intensive care units (ICUs), and even cost-effectiveness analysis of health care systems [13,19]. We considered whether the ACCI could be used as a useful inclusion / exclusion criterion for patients with ECPR.…”

Impact of Age-Adjusted Charlson Comorbidity on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation

“…Among them, the Charlson comorbidity index (CCI) [ 10 ] and age-adjusted CCI (ACCI) [ 11 ] have been repeatedly validated for estimating the longitudinal prognosis associated with multiple pre-existing comorbidities [ 12 , 13 ]. The ACCI has also been validated [ 14 ] in clinical scenarios, such as cancer [ 15 , 16 ], heart failure [ 17 ], infectious disease, emergency surgery [ 18 ], intensive care units (ICUs), and even the cost-effectiveness analysis of health care systems [ 13 , 19 ]. We considered whether the ACCI could be used as a useful inclusion/exclusion criterion for patients with ECPR.…”

Association between the Charlson comorbidity index and outcomes after implantable cardioverter defibrillator generator replacement

“…Bhavnani et al reported that the CCI is predictive of mortality within 1 year of initial ICD implantation. CCI score has also been shown to predict mortality in cardiac resynchronization therapy (CRT‐D) recipients . High CCI at the time of initial ICD implantation also predicts depression and poor physical health status .…”

“…CCI score has also been shown to predict mortality in cardiac resynchronization therapy (CRT-D) recipients. 20,21 High CCI at the time of initial ICD implantation also predicts depression and poor physical health status. 22 Importantly, in a combined analysis of four randomized trials of ICD implantation for primary prevention, the survival advantage conferred by ICD implantation was diminished in patients with ≥2 comorbidities compared to those with fewer comorbidities.…”