Implantable cardiac defibrillators and cardiac resynchronization therapy for heart failure in older adults

Heart failure primarily affects older adults, but these patients are underrepresented in clinical trials. Implantable cardiac defibrillators have been shown in large trials to reduce mortality through primary and secondary prevention of cardiac arrest. It is not clear, however, whether older patients derive the same mortality benefit as younger patients. Cardiac resynchronization therapy improves exercise tolerance and quality of life, and decreases mortality and hospitalizations for younger and older patients with heart failure. Each of these devices is underused in older patients, especially in women and minorities. Physician recommendation for device placement requires a discussion of indication, risks, and benefits, as well as plans for deactivation in end-stage disease.