Prevalence and prognostic impact of comorbidities in heart failure patients with implantable cardioverter defibrillator.

Aims: This study assessed the prevalence and the prognostic impact of comorbidities in heart failure patients with implantatable cardioverter-defibrillator (ICD).

Methods And Results: We prospectively enrolled 146 patients with chronic heart failure, an ICD, and systolic dysfunction (mean ejection fraction 29 +/- 10%). Cardiac death was chosen as the primary endpoint. Death or appropriate ICD therapy, i.e. antitachycardia pacing/shock due to sustained ventricular tachycardia or ventricular fibrillation, was chosen as the secondary endpoint. Seventy-five patients (52%) had chronic kidney disease (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2)), 39 patients (27%) were anaemic, and 34 patients (23%) had diabetes mellitus. During a follow-up of 663 +/- 400 days, 22 patients (15%) died, and 41 patients (28%) received an appropriate ICD therapy. By multivariate Cox analysis, independent predictors of cardiac death were chronic kidney disease, age, and NYHA functional class. Death/appropriate ICD therapy were independently predicted by chronic kidney disease and QRS duration. In the presence of chronic kidney disease, outcome was significantly worse when compared with the absence (event-free survival rate 51 vs. 76%, P < 0.001).

Conclusion: In heart failure patients with an ICD, comorbidities are frequent but only the presence of chronic kidney disease is independently associated with increased morbidity and mortality.