Evidence map›Paper›PMID 26224792›Full record

Trial reportCirculation. Heart failure2015

Clinical Risk Stratification for Primary Prevention Implantable Cardioverter Defibrillators.

Douglas S Lee, Judy Hardy, Raymond Yee, Jeffrey S Healey, David Birnie, Christopher S Simpson, Eugene Crystal, Iqwal Mangat, Kumaraswamy Nanthakumar, Xuesong Wang and 5 more

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in Circulation. Heart failure, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 2 pooled it
5.1field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 60 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Article
  4. Incidence and risk factors for first and recurrent ICD shock therapy in patients with an implantable cardioverter defibrillator.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025
    Article
  5. Article
  6. Article
  7. Article
  8. Review
  9. Article
  10. Article
  11. Review
  12. Article
  13. Development and external validation of prediction models to predict implantable cardioverter-defibrillator efficacy in primary prevention of sudden cardiac death.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2021
    Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Observational
  19. Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2018
    Article
  20. Observational
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 8 institutions in 1 country.

Douglas S LeeFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.). dlee@ices.on.ca.
Judy HardyFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Raymond YeeFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Jeffrey S HealeyFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
David BirnieFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Christopher S SimpsonFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Eugene CrystalFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Iqwal MangatFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Kumaraswamy NanthakumarFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Xuesong WangFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Andrew D KrahnFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Paul DorianFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Peter C AustinFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Jack V TuFrom the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.S.L., J.H., X.W., P.C.A., J.V.T.); Peter Munk Cardiac Centre (D.S.L., K.N.) and Joint Department of Medical Imaging (D.S.L.), University Health Network (D.S.L., K.N.), Institute for Health Policy, Management and Evaluation (D.S.L., P.C.A., J.V.T.), Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre (E.C., J.V.T.), and Division of Cardiology, Department of Medicine, St. Michael's Hospital (I.M., P.D.), University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada (R.Y.); Division of Cardiology, Department of Medicine, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada (J.S.H.); Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.B.); Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (C.S.S.); and Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (A.D.K.).
Investigators of the Ontario ICD Database
Hamilton Health Sciences · CAQueen's University · CAInstitute for Clinical Evaluative Sciences · CAHealth Sciences Centre · CAKingston General Hospital · CALondon Health Sciences Centre · CAMcMaster University · CAWestern University · CA

Funding

Canadian Institutes of Health Research MOP 111150
6 · The paper itself

Abstract

backgroundA conceptualized model may be useful for understanding risk stratification of primary prevention implantable cardioverter defibrillators considering the competing risks of appropriate implantable cardioverter defibrillator shock versus mortality. METHODS AND

resultsIn a prospective, multicenter, population-based cohort with left ventricular ejection fraction ≤35% referred for primary prevention implantable cardioverter defibrillator, we developed dual risk stratification models to determine the competing risks of appropriate defibrillator shock versus mortality using a Fine-Gray subdistribution hazard model. Among 7020 patients referred, 3445 underwent defibrillator implant (79.7% men, median, 66 years [25th, 75th: 58-73]). During 5918 person-years of follow-up, appropriate shock occurred in 204 patients (3.6 shocks/100 person-years) and 292 died (4.9 deaths/100 person-years). Competing risk predictors of appropriate shock included nonsustained ventricular tachycardia, atrial fibrillation, serum creatinine concentration, digoxin or amiodarone use, and QRS duration near 130-ms peak. One-year cumulative incidence of appropriate shock was 0.9% in the lowest risk category, and 1.7%, 2.5%, 4.9%, and 9.3% in low, intermediate, high, and highest risk groups, respectively. Hazard ratios for appropriate shock ranged from 4.04 to 7.79 in the highest 3 deciles (all P≤0.001 versus lowest risk). Cumulative incidence of 1-year death was 0.6%, 1.9%, 3.3%, 6.2%, and 17.7% in lowest, low, intermediate, high, and highest risk groups, respectively. Mortality hazard ratios ranged from 11.48 to 36.22 in the highest 3 deciles (all P<0.001 versus lowest risk).

conclusionsSimultaneous estimation of risks of appropriate shock and mortality can be performed using clinical variables, providing a potential framework for identification of patients who are unlikely to benefit from prophylactic implantable cardioverter defibrillator.

Indexed as

Defibrillators, ImplantableAgedCanadaDeath, Sudden, CardiacFemaleHumansIncidenceMaleMiddle AgedPrimary PreventionProspective StudiesRisk AssessmentRisk FactorsSurvival RateTachycardia, Ventricularcardiac arrhythmiadeathdecision makingdecision support techniquessudden cardiac deathventricular fibrillationventricular tachycardia

Identifiers

PMID26224792
PMCPMC4568903
OpenAlexW1891676651

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.