Reassessment of clinical variables in cardiac resynchronization defibrillator patients at the time of first replacement: Death after replacement of CRT (DARC) score

INTRODUCTION Cardiac resynchronization defibrillator (CRT-D) as primary prevention is known to reduce mortality. At the time of replacement, higher age and comorbidities may attenuate benefit implantable cardioverter-defibrillator (ICD) therapy. The purpose this study was evaluate progression after implantation their association with mortality following CRT-D generator replacement. In addition, a risk score developed identify patients at high for METHODS AND RESULTS We identified implanted (n = 648) who subsequently underwent elective replacement (n = 218) from two prospective ICD registries. cohort consisted 218 (median age: 70 years, male gender: 73%, mean left ventricular ejection fraction [LVEF]: 36 ± 11% replacement). Median follow-up 4.2 years during which 64 (29%) died 11 (5%) received appropriate shocks. An increase in observed 77 (35%). 5-year rate 41% ≥2 A incorporating age, gender, LVEF, atrial fibrillation, anemia, chronic kidney disease, history shocks accurately predicted (C-statistic 0.829). Patients greater than 2.5 had excess postreplacement compared less 1.5 (57% vs. 6%; p < .001). CONCLUSION simple predicts patients, are dying despite protection.