AimsComorbidity, such as myocardial infarction, diabetes, and renal failure, plays a pivotal role in the prognosis of a patient with arrhythmias. However, data on the prognostic impact of comorbiditiy in heart failure patients with cardiac resynchronization therapy and defibrillation (CRT-D) are scarce. The purpose of this study was to determine the impact of comorbidity on survival in CRT-D patients.Methods and resultsThe study population consisted of 463 heart failure patients who received a CRT-D between 1999 and 2008 in Rotterdam and Basel. The Charlson comorbidity index (CCI) is often used as an adjusting variable in prognostic models. The Cox proportional hazards analysis was performed to determine the independent effect of comorbidity on survival. During a median follow-up of 30.5 months, 85 patients died. Mortality rates at 1 and 7 years were 6.3 and 32.3. Cumulative incidence of implantable cardioverter defibrillator (ICD) therapy at 7 years was 50, and death without ICD therapy was observed in 9 of patients. At least three comorbid conditions were observed in 81 of patients. Patients who died had a higher CCI score compared with those who survived (3.9 ± 1.5 vs. 2.9 ± 1.5; P < 0.001). An age-adjusted CCI score <5 was a predictor of mortality (hazard ratio 3.69, 95 CI 2.066.60; P < 0.001) independent from indication for ICD therapy, and from ICD interventions during the clinical course.ConclusionComorbidity is often present in heart failure patients, and a high comorbidity burden was a significant predictor of mortality in CRT-D recipients. Comorbidity cannot predict appropriate ICD therapy. Death without prior ICD therapy occurs in a minor proportion of patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2010. For permissions please email: online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals. © Published on behalf of the European Society of Cardiology. All rights reserved.

Cardiac resynchronization therapy, Comorbidity, Implantable cardioverter-defibrillator, Mortality, Ventricular arrhythmia,
Erasmus MC: University Medical Center Rotterdam

Theuns, D.A.M.J, Schaer, B, Soliman, O.I.I, Altmann, D, Sticherling, C, Geleijnse, M.L, … Jordaens, L.J.L.M. (2011). The prognosis of implantable defibrillator patients treated with cardiac resynchronization therapy: Comorbidity burden as predictor of mortality. Europace, 13(1), 62–69. doi:10.1093/europace/euq328