An observational study revealed that frailty and severe comorbidity were strong predictors of death without appropriate therapy in patients with implantable cardioverter-defibrillators (ICDs), suggesting that certain patients may not benefit from ICD therapy.

David Wilson, MD

“Although ICDs decrease mortality by reducing the risk for sudden cardiac death, most patients with these devices do not receive life-prolonging therapy,” explained David Wilson, MD. “Older patients and those with numerous comorbidities may have an increased risk for non-arrhythmic death and therefore, the benefits of ICDs may be reduced.” He presented his findings at the 2023 European Heart Rhythm Association (EHRA) Congress, held from April 16-18, in Barcelona, Spain.¹

The current prospective, multicenter, observational COMFORT-Q study included 662 patients with ICDs to investigate the most important contributors to “death with no appropriate therapy,” the main outcome of the study. The study team asked participants to complete several health questionnaires including the Charlson comorbidity score, Fried score, 12-Item Short Form Survey (SF-12), and EQ5D-5L. A total of 77% of participants were male, the mean age was 65.6, 12% were considered frail, and 11% of participants had a severe Charlson comorbidity score.

A total of 63 participants died after a follow-up of 2.5 years. Of these patients, 54 had died without receiving appropriate ICD therapy. Frailty was the strongest independent predictor for death without appropriate therapy (OR 3.41; P<0.001). Severe comorbidity (OR 2.72; P<0.001) and estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m²(OR 2.16; P<0.001) were other significant predictors for this event.

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