The Impact of Charlson Comorbidity Index on De Novo Cardiac Implantable Electronic Device Procedural Outcomes in the United States

Rashid, Muhammad; Mamas, Mamas; Wu, Pensee

Abstract

OBJECTIVE: To investigate the utility of Charlson comorbidity index (CCI) as a measure of comorbidity burden to predict procedural outcomes after de novo cardiac implantable electronic device (CIED) implantation. METHODS: All de novo CIED implantations in the United States National Inpatient Sample between 2015 and 2018 were retrospectively analyzed, stratified by CCI score (0=no comorbidity burden, 1=mild, 2=moderate, =3=severe). Multivariable logistic regression models were performed to examine the association between unit CCI score (scale) and in-hospital outcomes (major adverse cerebrovascular and cardiovascular events [MACCE]: composite of all-cause mortality, acute ischemic stroke, thoracic and cardiac complications, and device-related complications; and MACCE individual components). RESULTS: Of 474,475 CIED procedures, the distribution of CCI score was as follows: CCI=0 (17.7%), CCI=1 (21.8%), CCI=2 (18.7%), and CCI=3+ (41.8%). Charlson comorbidity index score was associated with increased odds ratios of MACCE (1.10; 95% CI, 1.09 to 1.11), all-cause mortality (1.23; 95% CI, 1.21 to 1.25), and acute stroke (1.45; 95% CI, 1.44 to 1.46). This finding was consistent across all CIED groups except the cardiac resynchronization therapy groups in which CCI was not associated with increased risk of mortality. A higher CCI score was not associated with increased odds of procedural (thoracic and cardiac) and device-related complications. CONCLUSION: In a nationwide cohort of CIED procedures, higher comorbidity burden as measured by CCI score was associated with an increased risk of in-hospital mortality and acute ischemic stroke, but not procedure-related (thoracic and cardiac) or device-related complications. Objective assessment of comorbidity burden is important to risk-stratify patients undergoing CIED implantation for better prognostication of their in-hospital survival.

Citation

Rashid, M., Mamas, M., Wu, P., Mohamed, M. O., Van Spall, H. G. C., Morillo, C., Wilton, S. B., Kontopantelis, E., & Patwala, A. (2022). The Impact of Charlson Comorbidity Index on De Novo Cardiac Implantable Electronic Device Procedural Outcomes in the United States. Mayo Clinic Proceedings, 97(1), 88 - 100. https://doi.org/10.1016/j.mayocp.2021.06.029

• Journal Article Type: Article
• Acceptance Date: Jun 28, 2021
• Online Publication Date: Dec 1, 2021
• Publication Date: 2022-01
• Publicly Available Date: Jun 27, 2023
• Journal: Mayo Clinic Proceedings
• Print ISSN: 0025-6196
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 97
• Issue: 1
• Pages: 88 - 100
• DOI: https://doi.org/10.1016/j.mayocp.2021.06.029
• Public URL: https://keele-repository.worktribe.com/output/420498
• Publisher URL: https://www.mayoclinicproceedings.org/article/S0025-6196(21)00611-X/fulltext