Too ill for an implantable cardioverter defibrillator?

Abstract

Chong et al .1 propose that clinical markers of liver dysfunction, recent mechanical ventilation, and renal impairment, especially if simultaneous, are associated with increased mortality among patients carrying an implantable cardioverter defibrillator (ICD). Their research assists our understanding of current recommendations that only patients with reasonable expectation of survival with good functional status for >1 year should receive ICDs. Lacking standardization of ‘reasonable expectation of survival’, physicians ultimately rely on their clinical judgement. Accurate prognostication requires a multi-disciplinary assessment to quantify the impact of a specific organ dysfunction on survival. However, this simplified strategy still lacks sufficient predictive power. Chong et al . demonstrated that clinical comorbidities act synergistically to increase mortality risk. Patients with clinical markers involving ≥2 organ systems had a 38% 1-year mortality rate despite the ICD. By comparison, the conventional therapy group of MADIT-II (mean follow-up of 20 …