Open Heart. 2026 Jul 23;13(2):e003966. doi: 10.1136/openhrt-2026-003966.
ABSTRACT
BACKGROUND: For patients with a high risk of sudden cardiac death, despite the benefits of an implantable cardioverter defibrillator (ICD), some patients are still at high risk of death.
AIM: The purpose of this study was to develop and validate a nomogram predicting all-cause mortality for patients with an ICD.
METHODS: We retrospectively analysed the data of multicentre ICD registration study from 2010 to 2014 in China. A total of 617 ICD patients formed a development cohort. The physical activity monitored by ICD and clinical data was collected. Univariate and multivariate Cox regression analyses were used to screen mortality predictors and construct the nomogram. The performance of the nomogram was evaluated by the consistency index (C-index) and the calibration curve. Additionally, extensive subgroup and sensitivity analyses were conducted to evaluate the model's robustness. A total of 196 ICD patients formed a validation cohort.
RESULTS: In the development cohort, physical activity, diabetes and left ventricular end-diastolic diameter were selected as independent prognostic factors. The nomogram was constructed by these three factors. The C-index of the nomogram was 0.80 (95% CI 0.75 to 0.84). The calibration curve showed that the predicted survival probability of the nomogram was in good agreement with the actual survival probability. In the validation cohort, the C-index of the nomogram was 0.74 (95% CI 0.64 to 0.84), and the calibration curve still maintained good consistency. Crucially, the nomogram maintained stable and excellent discriminative capacity across primary and secondary prevention subgroups, as well as for predicting specific cardiac and sudden cardiac death.
CONCLUSIONS: Our study develops and validates a nomogram predicting all-cause mortality for patients with an ICD by integrating the physical activity monitored by ICD and clinical data. The nomogram performs well and can provide personalised death risk assessment for ICD patients.
TRIAL REGISTRATION NUMBER: ChiCTR-ONRC-13003695.
PMID:42493197 | DOI:10.1136/openhrt-2026-003966