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Impact of advanced age on survival in patients with implantable cardioverter defibrillators
Cara N Pellegrini1, Keane Lee, Jeffrey E Olgin
1Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA.
Insights
Age significantly impacts survival after implantable cardioverter defibrillator (ICD) implantation. Older patients, especially those over 75, face a substantially higher mortality risk, underscoring age as a critical factor in predicting outcomes.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Clinical trials for implantable cardioverter defibrillators (ICDs) often exclude or underrepresent elderly populations.
- Limited data exists on the overall applicability of ICD trial findings to elderly patients.
Purpose of the Study:
- To investigate the influence of patient age on mortality following ICD implantation.
- To determine if age is an independent predictor of survival after receiving an ICD.
Main Methods:
- Retrospective cohort study of 502 patients who received ICDs between 1993 and 2003.
- Patient age was categorized (<65, 65-75, >75 years) as the primary predictor.
- Time to death was the primary outcome, with a mean follow-up of 4 years.
Main Results:
- Median survival was significantly lower for patients over 75 years (5.3 years) compared to younger groups.
- Elderly patients (>75 years) had a 4.7-fold increased risk of death (HR, 4.7; P < 0.001) versus those <65 years.
- Increased age was independently associated with higher total, cardiac, and non-cardiac mortality.
Conclusions:
- Age at ICD implantation is a strong, independent predictor of mortality.
- Age should be a key consideration when evaluating survival prognosis for elderly patients undergoing ICD implantation.
Aims:
Given the selectivity of clinical trial patients and meager representation of elderly in the major implantable cardioverter defibrillator (ICD) randomized trials (<25%), whether such data apply to elderly patients overall is unclear. The purpose of our study is to understand the influence of age on mortality after ICD implantation.
Methods And Results:
We performed a retrospective cohort study of 502 consecutive patients receiving ICDs from 1993 to 2003 at a single university hospital. The primary predictor was patient age, categorized as <65, 65-75, and >75 years at ICD implantation. The primary outcome was time to death. Mean follow-up was 4 years. Median survival after ICD implantation was 5.3 years among subjects >75 years, less than half that of the youngest group. After adjusting for potential confounders, compared with subjects <65 years of age, patients >75 years [hazard ratio (HR), 4.7; 95% confidence interval (CI), 2.8-7.9; P < 0.001] and those 65-75 years (HR, 2.8; 95% CI, 1.7-4.8; P < 0.001) were at greater risk of death. Increased age was associated with higher total, cardiac, and non-cardiac mortality (all P
Conclusion:
Age at ICD implantation is strongly and independently associated with mortality. Age should be considered among potential co-morbidities in anticipating survival of the elderly patient prior to ICD implantation.
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