Heart failure & cardiomyopathiesCohort study
Frailty and risk of death without device therapy among patients with primary prophylaxis implantable cardioverter-defibrillators: The CERTITUDE Registry
- Registry study linked to Medicare claims
Authors' conclusion
Frailty is associated with higher risks of death without ICD therapy and all-cause mortality among patients undergoing primary prevention ICD.
Study context
- Population
- Adults aged ≥66 years with heart failure who underwent primary prevention implantable cardioverter-defibrillator (ICD) implantation between 1 January 2015 and 22 December 2022adults with heart failure who underwent primary prevention ICD implantation, 12.1% (128) frail
- Participants
- 1,060 adults
- Exposure
- frail vs robust
- frailn = 128
- Outcome
- Death without ICD therapy
- Follow-up
- up to 5-years
Main finding
As reported in the abstract
Hazard ratio
1.92
95% CI 1.12–3.29
By group
frail vs robust
hazard ratio 1.92 (95% CI 1.12–3.29)
Observational data: associations, not effects.
Further findings
| Outcome | robust | pre-frail | frail | hazard ratio (95% CI) | |
|---|---|---|---|---|---|
| All-cause mortality · adjusted for age, sex, and comorbidities | 26.3% | 37.3% | 55.5% | 1.66 (1.07–2.58) | |
| 0.20.5125Hazard ratio (log scale) |
- All-cause mortality: P < .001 across frailty groups
Frailty threshold · 5-year
- CFI threshold where predicted risk of death without ICD therapy exceeded risk of ICD therapy
- CFI = 0.20
Original publication
Frailty and risk of death without device therapy among patients with primary prophylaxis implantable cardioverter-defibrillators: The CERTITUDE Registry. Heart Rhythm. Published 7 January 2026. doi:10.1016/j.hrthm.2026.01.003
Summarised from the published abstract; every number is checked against it