Increasing age does not affect time to appropriate therapy in primary prevention ICD/CRT-D: a competing risks...

Area of Science:

• Cardiology
• Electrophysiology
• Geriatric Medicine

Background:

• Primary prevention implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) devices are crucial for managing heart failure.
• The aging population necessitates an understanding of how age impacts the effectiveness and risks associated with these devices.

Purpose of the Study:

• To evaluate the impact of patient age on clinical outcomes in primary prevention ICD/CRT-D recipients.
• To identify age-related competing risks that influence mortality in this population.

Main Methods:

• Retrospective, multicentre analysis of 424 patients aged 60 years and over receiving primary prevention ICD/CRT-D.
• Follow-up measured survival without therapy, death without therapy, and appropriate therapy delivery with survival or death.

Main Results:

• Age at implant did not significantly impact the cumulative incidence of appropriate therapy (SHR 1.00, P=0.851).
• Each year increase in age at implant was associated with a 6% increase in the cumulative incidence of death prior to therapy (SHR 1.06, P<0.001).
• Ischaemic aetiology, low baseline haemoglobin, and diabetes mellitus were also predictors of all-cause mortality.

Conclusions:

• Age does not influence the timing of appropriate therapy delivery in primary prevention ICD/CRT-D patients.
• The risk of death increases with age due to competing risks, independent of the device's primary indication.
• Characterizing these competing risks is essential for optimizing therapy selection and minimizing device-related morbidity in an aging patient cohort.