Abstract 13308: Are Current Unplanned or Recent Hospitalizations Due to Non-Heart Failure Reasons Associated With Worse Outcomes After Implantable Cardioverter-Defibrillator Placement in Medicare Beneficiaries With Heart Failure?

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Introduction: Elective ICD placement is efficacious for patients with chronic stable HF. ICD placement during or shortly after HF hospitalizations has been associated with worse outcomes. However, the impact of ICD placement in relation to non-HF hospitalizations is unknown. Methods: We identified all ICDs placed among older (age ≥ 66) HF patients without prior cardiac arrest using 20% random sample Medicare data (2008-2018). Setting of ICD was classified as: during unplanned 1) HF hospitalization or 2) non-HF hospitalization, within ≤ 3 months of 3) HF hospitalization or 4) non-HF hospitalization, or 5) electively during planned hospitalization or as outpatient. Non-HF hospitalization was defined as hospitalization without a primary or secondary HF diagnosis. We described patient characteristics and 3-yr mortality across these 5 settings. We estimated adjusted hazard ratios (HRs) using multivariable Cox regression with elective as reference. Results: Among 97,925 ICD patients (mean age 76, 67% male, 85% white), those getting ICDs during unplanned or after recent HF or non-HF hospitalizations were older and had more comorbidities vs elective patients ( Table ). The 3-year mortality after elective ICD placement was 21% but > 35% in non-elective groups. After adjustment, HR was significantly higher in unplanned HF (HR = 1.7), recent HF (HR= 1.6), unplanned non-HF (HR = 1.4), and recent non-HF (HR = 1.5) groups ( Figure). Conclusions: ICD placement during unplanned or after recent hospitalization is associated with worse outcomes, irrespective of hospitalization reasons. Randomized trials to understand appropriate settings of ICD placement are needed to maximize the benefit.