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Implantable cardioverter-defibrillator use in elderly patients receiving cardiac resynchronization: A meta-analysis
Ahmed AlTurki1, Riccardo Proietti2, Hasan Alturki3
1Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University Health Center, Quebec, Canada.
Insights
Implantable cardioverter-defibrillators (ICDs) are less often used in elderly patients (≥75 years) receiving cardiac resynchronization therapy (CRT). Further research is needed to guide ICD use in this growing population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are vital for managing heart failure with reduced ejection fraction (HFrEF).
- Current guidelines lack age restrictions for ICD/CRT but advise against use in frail patients with <1 year life expectancy.
- The comparative benefit of ICDs in elderly versus younger patients undergoing CRT remains unclear.
Purpose of the Study:
- To assess the utilization patterns of ICDs in elderly patients (≥75 years) compared to younger patients undergoing CRT.
- To analyze the differences in ICD implantation rates between these age groups.
Main Methods:
- A systematic search of electronic databases was conducted up to April 11, 2016.
- Meta-analysis of six observational studies involving 613 elderly and 2810 younger patients receiving CRT.
- Random-effects models were used to summarize baseline characteristics and ICD implantation rates.
Main Results:
- Elderly patients (mean age 82.7 years) showed significantly lower ICD use (37.9%) compared to younger patients (mean age 66.3 years, 64.3%).
- The odds ratio for ICD use in elderly versus younger patients was 0.26 (95% CI: 0.14-0.46, p < 0.0001).
Conclusions:
- ICD implantation is less frequent in elderly patients (≥75 years) undergoing CRT compared to their younger counterparts.
- Further research is essential to evaluate the efficacy and effectiveness of ICDs in elderly CRT candidates to inform clinical management.
Background:
Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce sudden cardiac death and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoidance of ICD and CRT in frail patients with a life expectancy of less than 1 year. It remains unclear whether elderly patients undergoing CRT derive the same additional benefit from ICDs as younger patients. We aimed to assess the use of ICDs in elderly compared to younger patients receiving CRT.
Methods:
We searched electronic databases, up to April 11, 2016, for all studies reporting on ICD use stratified by age in patients who received CRT. We used random-effects meta-analysis models to calculate the summarized baseline characteristics and rates of implantation of ICD among patients enrolled in the studies.
Results:
We retained six observational studies enrolling 613 patients ≥75 years old and 2810 patients <75 years old. The aggregate mean age was 82.7 years for the elderly patients compared to 66.3 years in the younger patients. There was a significantly lower use of ICDs in elderly patients compared to that in younger patients (37.9% versus 64.3%) (odds ratio: 0.26; 95% confidence intervals: 0.14-0.46; p < 0.0001).
Conclusions:
In conclusion, ICD was less frequently used in patients ≥75 years old receiving CRT compared to younger patients receiving CRT. Future studies that evaluate the efficacy and effectiveness of ICDs in elderly patients with indications for CRT are needed to guide management of this increasing population.
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