Novel scoring system for predicting mortality in patients with ventricular arrhythmias: Analysis from a 24,000 patient cohort

Abstract

Abstract Background Several scoring systems have been developed to predict mortality in ventricular tachycardias (VT) in selected populations (for example, patients undergoing ablation) with limited follow-up times. We aimed to develop a simple scoring system to predict all-cause mortality in a large cohort of VT patients followed up for >10 years. Methods We mined electronic data from 2008 to 2022 from a large suburban academic and community healthcare system, for the endpoint of all-cause mortality in adults diagnosed with ventricular tachycardia using the ICD 10 code of I47.2. We related the endpoint to covariates including sex, race, socioeconomic factors and comorbidities identified with standard ICD codes (prior to the diagnosis of VT) using cox-proportional hazards model. We then tested a scoring system using coefficients developed in the training cohort (70%) in an independent test cohort. Results We identified 24278 adult patients diagnosed with VT. Of these, 2921 (12%) died within 249 (23,1095) days of diagnosis. Figure 1 shows factors associated with mortality, adjusted for race, gender and ethnicity, which were: congestive heart failure [HR:1.78; (1.62,1.96)] chronic kidney disease [HR:1.75; (1.60,1.91)] ,atrial fibrillation[HR:1.53; (1.40,1.67)], diabetes [HR:1.47; (1.35,1.61)] , coronary artery disease [HR:1.57; (1.43, 1.72)] , peripheral arterial disease [HR:1.29; (1.17,1.42)] , hypertension [HR:1.39; (1.26,1.54) , COPD [HR:1.21,1.50)] , and hyperlipidemia [HR:-.87; (0.80 -0.95)] . The novel 9-point (CKAD(ICV)SHL) score predicts mortality with a C-index of 0.66. Conclusions In a population of over 20 thousand patients with ventricular arrhythmias, a scoring system based on heart failure, CKD, AF and other factors predicts mortality. This may form a basis for revised efforts for screening, risk stratification and trial design for ICD placement and guideline directed medical management.