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Causes and prevention of sudden cardiac death in the elderly

Patricia Tung1, Christine M Albert

  • 1Brigham & Women's Hospital, Division of Preventive Medicine, 900 Commonwealth Avenue East, Boston, MA 02215, USA. ptung@partners.org

Nature Reviews. Cardiology
|January 30, 2013
PubMed

Insights

Sudden cardiac death (SCD) risk increases with age, but implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) effectiveness in elderly patients requires further study due to competing nonarrhythmic causes of death.

Area of Science:

  • Cardiology
  • Geriatrics
  • Medical Technology

Background:

  • Sudden cardiac death (SCD) is a significant cause of mortality in the elderly, often linked to coronary heart disease, systolic dysfunction, and congestive heart failure (CHF).
  • While SCD incidence rises with age, its proportion among all cardiac deaths decreases due to other cardiac causes prevalent in older individuals.
  • Elderly patients are increasingly receiving implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) for primary prevention, despite under-representation in clinical trials.

Purpose of the Study:

  • To review the specific causes of sudden cardiac death (SCD) in elderly individuals.
  • To evaluate the existing evidence on the effectiveness of implantable cardioverter-defibrillator (ICD) therapy in this demographic.
  • To discuss the role and effectiveness of cardiac resynchronization therapy (CRT) in older patients with heart failure.

Main Methods:

  • Review of existing literature and clinical trial data concerning SCD in the elderly.
  • Analysis of the efficacy of implantable cardioverter-defibrillator (ICD) therapy in older populations.
  • Examination of data on cardiac resynchronization therapy (CRT) use and outcomes in elderly patients with heart failure.

Main Results:

  • Implantable cardioverter-defibrillator (ICD) therapy may be less effective in elderly patients due to a higher incidence of pulseless electrical activity in SCD and competing nonarrhythmic causes of death.
  • Elderly patients represent a substantial portion of those qualifying for and receiving ICDs for primary prevention, despite limited representation in randomized trials.
  • Cardiac resynchronization therapy (CRT) is more commonly used in elderly patients compared to younger individuals, with demonstrated mortality reduction in selected heart failure populations.

Conclusions:

  • The effectiveness of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) in elderly individuals with heart failure needs careful consideration due to age-related factors influencing SCD and overall mortality.
  • Further research is warranted to optimize the use of these devices in the growing elderly population at risk for sudden cardiac death.
  • Understanding the balance between arrhythmic and nonarrhythmic death causes is crucial for guiding therapeutic decisions in older patients.

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