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Device therapy in patients with heart failure and advanced age: too much too late?

Raymond Cutro1, Michael W Rich, Paul J Hauptman

  • 1Brigham and Women's Hospital, Harvard University, Boston, MA, USA.

International Journal of Cardiology
|February 24, 2011
PubMed

Insights

Implantable cardioverter-defibrillators (ICDs) offer limited benefit for most patients over 75, while cardiac resynchronization therapy (CRT) may improve quality of life in select elderly heart failure patients.

Area of Science:

  • Cardiology
  • Geriatrics
  • Biomedical Engineering

Background:

  • Increasing prevalence of implantable cardiac rhythm devices in aging populations.
  • Limited data on the efficacy and safety of device therapy in patients over 75 years old.

Purpose of the Study:

  • To review the evidence for implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) in elderly heart failure patients.
  • To assess efficacy, complications, indications, cost, and controversies of device therapy in the geriatric population.

Main Methods:

  • Systematic review of current evidence on ICDs and CRT in elderly heart failure patients.
  • Analysis of major device trials, focusing on participants over 75 years of age.

Main Results:

  • Implantable cardioverter-defibrillators (ICDs) show reduced net clinical benefit in most patients over 75 due to higher complication rates and costs.
  • Cardiac resynchronization therapy (CRT) demonstrates improved quality of life in elderly patients at acceptable costs.

Conclusions:

  • ICDs are unlikely to be favorable for most patients over 75-80 years.
  • Cardiac resynchronization therapy (CRT) is a potentially attractive option for carefully selected elderly patients with heart failure.

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