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Published on: February 28, 2012
Age differences of patients treated with wearable cardioverter defibrillator: Data from a multicentre registry
Ibrahim El-Battrawy1,2,3, David Tenbrink1, Boldizsar Kovacs4
1Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.
Insights
Younger patients using wearable cardioverter defibrillators (WCD) showed lower compliance but similar clinical outcomes compared to older adults. This highlights the need to optimize WCD use across different age groups for sudden cardiac death prevention.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Wearable cardioverter defibrillators (WCD) serve as a crucial temporary bridge therapy for patients at high risk of sudden cardiac death (SCD).
- Effective WCD prescription necessitates careful consideration of patient selection, treatment adherence, and optimal pharmacological management.
- Real-world data comparing WCD outcomes across different age demographics is essential for refining clinical practice.
Purpose of the Study:
- To analyze and compare the outcomes, prognosis, WCD usage data, and compliance rates between younger (<45 years) and older (≥45 years) patient groups.
- To identify age-specific factors influencing WCD prescription and adherence.
- To evaluate the effectiveness of WCD as a bridging therapy across diverse age populations.
Main Methods:
- A registry-based study including 1105 patients from seven centers in Germany and Switzerland between April 2012 and March 2021.
- Comparative analysis of outcomes, WCD wear time, incidence of life-threatening arrhythmias, appropriate shock delivery, and device implantation rates between younger and older patient cohorts.
- Assessment of left ventricular ejection fraction improvement and all-cause/arrhythmic mortality during follow-up.
Main Results:
- Younger patients more frequently received WCDs for congenital heart disease and myocarditis, while older patients predominantly had ischemic cardiomyopathy.
- Despite similar WCD wear duration and comparable rates of life-threatening arrhythmic events and appropriate shocks, younger patients exhibited lower compliance (68.9% vs. 80.9%).
- Younger patients showed better left ventricular ejection fraction improvement, a lower rate of permanent device implantation, and similar mortality rates compared to older patients.
Conclusions:
- While overall compliance with WCD use is high, younger patients tend to wear the device for fewer hours than older patients.
- Clinical events and mortality rates were comparable between the age groups, suggesting WCD effectiveness across different demographics.
- Low compliance is associated with younger age and non-ischemic cardiomyopathies, indicating a need for targeted interventions to improve adherence.
Background:
Wearable cardioverter defibrillators (WCD) are used as a 'bridging' technology in patients, who are temporarily at high risk for sudden cardiac death (SCD). Several factors should be taken into consideration, for example patient selection, compliance and optimal drug treatment, when WCD is prescribed. We aimed to present real-world data from seven centres from Germany and Switzerland according to age differences regarding the outcome, prognosis, WCD data and compliance.
Materials And Methods:
Between 04/2012 and 03/2021, 1105 patients were included in this registry. Outcome data according to age differences (old ≥45 years compared to young <45 years) were analysed. At young age, WCDs were more often prescribed due to congenital heart disease and myocarditis. On the other hand, ischaemic cardiomyopathy (ICM) was more present in older patients. Wear days of WCD were similar between both groups (p = .115). In addition, during the WCD use, documented arrhythmic life-threatening events were comparable [sustained ventricular tachycardia: 5.8% vs. 7.7%, ventricular fibrillation (VF) .5% vs. .6%] and consequently the rate of appropriate shocks was similar between both groups. Left ventricular ejection fraction improvement was documented over follow-up with a better improvement in younger patients as compared to older patients (77% vs. 63%, p = .002). In addition, at baseline, the rate of atrial fibrillation was significantly higher in the older age group (23% vs. 8%; p = .001). The rate of permanent cardiac implantable electronic device implantation (CiED) was lower in the younger group (25% vs. 36%, p = .05). The compliance rate defined as wearing WCD at least 20 h per day was significantly lower in young patients compared to old patients (68.9% vs. 80.9%, p < .001). During the follow-up, no significant difference regarding all-cause mortality or arrhythmic death was documented in both groups. A low compliance rate of wearing WCD is predicted by young patients and patients suffering from non-ischaemic cardiomyopathies.
Conclusion:
Although the compliance rate in different age groups is high, the average wear hours tended to be lower in young patients compared to older patients. The clinical events were similar in younger patients compared to older patients.
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