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ICD therapy in the elderly: a retrospective single-center analysis of mortality
Cornelia Scheurlen1, Jan van den Bruck2, Jonas Wörmann2
1Department of Electrophysiology, Cologne, University Heart Center Cologne, Kerpener Str. 62, 50937, Köln, Germany. cornelia.scheurlen@uk-koeln.de.
Insights
Mortality is high in elderly patients receiving implantable cardioverter-defibrillators (ICDs). Patients aged 80 and over had a 56% one-year mortality rate, suggesting careful consideration for ICD implantation in this demographic.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Devices
Background:
- Current implantable cardioverter-defibrillator (ICD) guidelines lack age limitations but require patients to have a one-year survival expectancy.
- Increasing age is associated with higher comorbidity and non-sudden cardiac death mortality, questioning the benefit of ICD therapy in the elderly.
Purpose of the Study:
- To assess mortality rates following ICD implantation (IMPL) or generator exchange (GE) in patients aged 75 years and older.
- To evaluate the impact of age on outcomes in elderly patients undergoing ICD procedures.
Main Methods:
- A retrospective analysis of consecutive patients aged 75 years and older who underwent ICD IMPL or GE between January 2013 and December 2017.
- Data collection included patient demographics, procedure type, follow-up duration, mortality, and ICD therapies.
Main Results:
- Of 82 eligible patients (20% of 418), 70 had available follow-up (median 3.1 years). Overall, 57% died during follow-up.
- One-year mortality was 27% overall, 17% for patients 75-79 years, and 56% for patients 80 years and older.
- Deceased patients were more likely to have chronic renal failure (85% vs. 53%) and peripheral artery disease (18% vs. 0%).
Conclusions:
- One-year mortality in patients aged 80 and over receiving an ICD was 56%, rising to 72% at two years.
- The decision for ICD implantation in elderly patients requires careful, individualized assessment due to significant mortality risks.
Background:
Current implantable cardioverter-defibrillator (ICD) guidelines do not impose age limitations for ICD implantation (IMPL) and generator exchange (GE); however, patients (pts) should be expected to survive for 1 year. With higher age, comorbidity and mortality due to non-sudden cardiac death increase. Thus, the benefit of ICD therapy in elderly pts remains unclear. Mortality after ICD IMPL or GE in pts ≥ 75 years was assessed.
Methods:
Consecutive pts aged ≥ 75 years with ICD IMPL or GE at the University Hospital Cologne, Germany, between 01/2013 and 12/2017 were included in this retrospective analysis.
Results:
Of 418 pts, 82 (20%) fulfilled the inclusion criteria; in 70 (55 = IMPL, 79%, 15 = GE, 21%) follow-up (FU) was available. The median FU was 3.1 years. During FU, 40 pts (57%) died (29/55 [53%] IMPL; 11/15 [73%] GE). Mean survival after surgery was 561 ± 462 days. The 1‑year mortality rate was 19/70 (27%) overall, 9/52 (17%) in pts ≥ 75 and 10/18 (56%) in pts ≥ 80 years. Deceased pts were more likely to suffer from chronic renal failure (85% vs. 53%, p = 0.004) and peripheral artery disease (18% vs. 0%, p = 0.02). During FU, seven pts experienced ICD shocks (four appropriate, three inappropriate). In primary prevention (n = 35) mortality was 46% and four pts experienced ICD therapies (two adequate); in secondary prevention (n = 35) mortality was 69% (p = 0.053) with three ICD therapies (two adequate).
Conclusion:
Mortality in ICD pts aged ≥ 80 years was 56% at 1 and 72% at 2 years in this retrospective analysis. The decision to implant an ICD in elderly pts should be made carefully and individually.
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