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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Predictors of early mortality in patients age 80 and older receiving implantable defibrillators
Drew Ertel1, Kavita Phatak, Kevin Makati
1Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, Illinois, USA.
Insights
Implantable defibrillator (ICD) benefit in patients 80+ years is limited if ejection fraction is low (≤20%). These patients have higher early mortality, reducing ICD therapy benefit.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Implantable defibrillators (ICDs) lack upper age limits, but efficacy in patients aged 80 and above with high mortality risk is debated.
- Predictors of early mortality in elderly ICD recipients remain unclear.
Purpose of the Study:
- To identify risk factors for 1-year mortality in patients aged 80 and older receiving ICDs.
- To evaluate the benefit of ICD therapy in this specific elderly population.
Main Methods:
- A retrospective cohort study was conducted across two centers.
- Data from 225 patients aged 80 and above who received ICDs between 1990 and 2006 were analyzed.
Main Results:
- Multivariate analysis identified ejection fraction (EF) ≤20% and lack of beta-blocker use as predictors of 1-year mortality.
- One-year mortality was significantly higher in patients aged 80+ with EF ≤20% (38.2%) compared to those with EF >20% (13.1%) or patients under 80 with EF ≤20% (10.6%).
- Appropriate ICD therapy rates did not differ significantly between elderly patients with EF above or below 20%.
Conclusions:
- While many elderly patients (80+) benefit from ICDs based on survival, those with EF ≤20% face elevated early mortality.
- The reduced benefit of ICD therapy in elderly patients with severely impaired EF warrants careful consideration for device implantation.
Background:
There are no upper age restrictions for implantable defibrillators (ICDs) but their benefit may be limited in patients > or = 80 years with strong competing risks of early mortality. Risk factors for early (1-year) mortality in ICD recipients > or = 80 years of age have not been established.
Methods:
Two-center retrospective cohort study to assess predictors of one-year mortality in ICD recipients > or = 80 years of age.
Results:
Of 2,967 ICDs implanted in the two centers from 1990-2006, 225 (7.6%) patients were > or =80 years of age and followed-up at one of the two centers. Mean age was 83.3 +/- 3.1 years and follow-up time 3.3 +/- 2.6 years. Median survival was 3.6 years (95% confidence interval 2.3-4.9). Multivariate predictors of 1-year mortality included ejection fraction (EF) < or = 20% and the absence of beta-blocker use. Actuarial 1-year mortality of ICD recipients > or = 80 with an EF < or = 20% was 38.2% versus 13.1% in patients 80+ years with an EF > 20% and 10.6% for patients < 80 years with an EF < or = 20% (P < 0.001 for both). There was no significant difference in the risk of appropriate ICD therapy between those patients 80+ years with EF above and below 20%.
Conclusion:
In general, patients > or = 80 years of age who meet current indications for ICD implantation live sufficiently long to warrant device implantation based on anticipated survival alone. However, those with an EF < or = 20% have a markedly elevated 1-year mortality with no observed increase in appropriate ICD therapy, thus reducing the benefit of device implantation in this population.
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